Factors that influence improvement for patients with poorly controlled type 2 diabetes

Assess reasons for improved control for patients with initially poorly controlled diabetes.

Patients in seven practices with type 2 diabetes were selected if within a 6-month period they had two glycosylated hemoglobin (HbA1c) levels of at least 8.0%. Patient factors that may influence control were compared for patients grouped according to their last two HbA1c levels.

Review of 643 medical records of diabetic patients treated by 29 clinicians identified 69 study patients. After at least 1 year of follow-up 26 patients became well controlled, 14 had intermediate control, and 29 remained in poor control. Becoming controlled was not significantly associated with gender, age, duration of diabetes, BMI, or HbA1c levels prior to baseline. It was inversely associated with greater use of medications (P = 0.04), and positively associated with understanding of diabetes (P = 0.03), adherence to recommendations for meal plan (P = 0.001), and glucose monitoring (P = 0.02). Thirty-one percent of patients who became controlled had a change in life circumstances. Reasons for not advancing medications were probably justified for 69% of patients who remained uncontrolled.

Improved control depends largely on patient self-care behaviors.