Patterns of glycaemic control in Australian primary care (NEFRON 8)

Intensive glycaemic control delays the onset and progression of diabetes-related complications, especially microvascular complications. However, only limited information is available regarding glucose-lowering treatment practices in Australian primary care. The aim of the study was to describe patterns of glycaemic control in subjects participating in the National Evaluation of the Frequency of Renal Impairment co-existing with Non-Insulin Dependent Diabetes Mellitus study.

Expressions of interest were invited from all registered general practitioners in Australia, from which 500 investigators were randomly selected and asked to provide data on 10-15 consecutive adults with type 2 diabetes presenting to their practice.

Just less than half of the 3893 enrolled patients had a haemoglobin (Hb)A(1c) <7.0% (47.7%, 95% confidence interval (CI) 46.1-49.3%) and quarter had an HbA(1c)> or =8.0% (24.3%, 95%CI 22.9-25.9%. For patients using lifestyle alone, one or two oral glucose-lowering agents or insulin there was a progressive decline in the proportion achieving an HbA(1c) <7.0%, that is, 81, 55, 31 and 24%, respectively. There was a very good concordance between general practitioners' perception of optimal control (HbA(1c) <7.0%) and the actual glycaemic levels achieved in this study.

Current targets for glycaemic control in type 2 diabetes have generally been followed in Australian general practice, but there is still a significant gap in the achievement of recommended glycaemic goals. A quarter of the patients clearly have poor glycaemic control. The immediate steps that can be taken to improve glycaemic control include the early use of combination oral glucose-lowering therapies and the increased use of insulin.