TYPE 2 DIABETES MELLITUS: HOW WELL CONTROLLED IN OUR PATIENTS?
Abstract
Background: Type 2 Diabetes mellitus has reached epidemic proportions worldwide and Pakistan is noexception. This study was done to see the glycaemic control of our diabetic patients by estimatingGlycosylated haemoglobin & Fasting blood glucose as poor control leads to significant complicationscausing enormous human suffering & socioeconomic burden. Method: This Cross-sectional study wasconducted on Type 2 diabetic patients coming to medical OPD and medical B ward of Ayub TeachingHospital between March–September 2007 fulfilling the inclusion criteria. Results: Among 100 patientswith type 2 diabetes forty two had HbA1c more than 7.5 %, while seventy had fasting blood glucose morethan 120 mg/dl. All patients with HbA1c more than 7.5% had increased fasting blood glucose. While thirtyout of seventy patients with fasting blood glucose more than 120 mg/dl had HbA1c less than 7.5%. Noneof the patients with fasting blood glucose less than 120 mg/dl had HbA1c more than 7.5%. Conclusions:Significant number of patients (42%) had poor control of diabetes as revealed by HbA1c, with FBGshowing poor control in even more patients, i.e., 70%. However their blood glucose estimation was notfrequent enough as required. Blood glucose results can be spuriously high and may lead to frequentchange/ increase in the dose of hypoglycaemic medications. This can lead to poor compliance as well aspsychological trauma to patients. HbA1c on the other hand is easy to interpret, reflects long termglycaemic control and cost effective. We recommend its more frequent use along with blood glucose forbetter glycaemic control and decreased chances of complications.Keywords: Glycosylated Haemoglobin, Fasting Blood Glucose, Type 2 Diabetes mellitusReferences
World health organization, Definition, diagnosis and
classification of diabetes mellitus and its complications.
Report of a WHO consultation. Part 1; Diagnosis and
classification of diabetes mellitus .Geneva; World Health
Organization, 1999.
Expert Committee on the Diagnosis and Classification of
Diabetes Mellitus. Report of the Expert Committee on the
Diagnosis and Classification of Diabetes Mellitus. Diabetes
Care. 1997;20:1183–97.
Scheen AJ, Lefebvre PJ. In; Di Mario U, Leonetti F, Pugliese
G, Sbraccia P, Signore A, eds. Diabetes in the New
Millennium New York: Wiley and sons; 2000.p 101–13.
UK Prospective Diabetes study (UKPDS) group. Intensive
blood glucose control with sulphonylureas or insulin
compared with conventional treatment and the risk of
complications in patients with type II DM (UKPDS 33)
Lancet 1998;352:837–53.
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE,
Cull CA et al. Association of glycemia with macrovascular
and microvascular complications of type 2 diabetes (UKPDS
: prospective observational study. BMJ 2000;321:405–12.
Evans JMM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ,
Morris AD. Frequency of blood glucose monitoring in relations to
glycaemic control: observational study with diabetes database. BMJ
;319:83–6.
DCCT Research Group. The effect of intensive treatment of
diabetes on development and progression of long-term
complications in insulin dependant diabetes mellitus. N Eng
J Med 1989;329;977–86
Davis M, Day J. Screening for NIDDM; how often should it
be performed. J Med Screening. 1994;1:78–81.
American Diabetes Association. Consensus statement on self–
monitoring of blood glucose. Diabetes Care 1994;17:81–6.
Harris MI, Cowie CC, Howie LJ. Self monitoring of blood
glucose by adults with diabetes in the United States
population. Diabetes care. 1993;16:1116–23.
Peters AL, Davidson MB, Schriger DL, Hasssel Blad V. A
clinical approach for the diagnosis of diabetes mellitus ; an
analysis using glycosylated haemoglobin levels. JAMA
;1996:1246–52.
Clutter WE: Meta-analysis: glycosylated hemoglobin levels
are useful for diagnosing diabetes. ACP Jrn Club
;1997:46.
American Diabetes Association : Screening for diabetes
(position statement).Diabetes Care 2002;25(Suppl-1);S21–S24.
Alberti K, Zimmer P. Definition, diagnosis and classification
of Diabetes mellitus and its complications, part1: diagnosis
and classification of diabetes mellitus, provisional report of a
World Health Organization consultation. Diabet
Med.1998;15:539–53.
Basit A, Hakeem R. Hydrie Z I, Ahmedani Y, Masood Q.
Frequency of chronic complications of type 2 diabetes in
subjects attending a tertiary care unit in Karachi,
Pakistan.18th International Diabetes Federation Congress,
PARIS 2003;1–40.
Silverman. The Relationship of plasma Glucose and HbA1c
Levels among Emergency Department patents with no prior
history of Diabetes Mellitus. Acad Emerg Med 2006;13:722–6.
Patrick AW, Gill GV, MacFarlane IA, Cullen A, Power E,
Wallymahmed M. Home glucose monitoring in type 2 DM:
is it waste of time? Diabetic Med 1994;11:62–5.
Kilpatrick. Glycated haemoglobin in the year 2000. J Clin
Pathol 2000;53:335–9.
David MN, John BB, Mayer BD, Robert JH, Rury RH,
Robert S, Bernard Z. Management of Hyperglycemia in Type
Diabetes: A consensus algorithm for initiation and
adjustment of therapy; A consensus statement from the
American Diabetes Association and the European
Association for the Study of Diabetes. Diabetes Care
;29:1963–72.
Sacks DB, Burns DE, Goldstein DE, Maclaren NK,
McDonald JM, Parrott M. Guidelines and recommendations
for laboratory analysis in the diagnosis and management of
diabetes mellitus. Clin Chem 2002;48:436–72.
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