Individualized Management Can Improve Glycemic Control

The authors wrote, "Improving glycemic control in certain populations can be difficult. Whilst therapeutic advances in glycemic management have become available, and significant improvements in primary care management of diabetes have occurred over the last few years, there remains a significant cohort of patients with type 2 diabetes who have extremely poor glycemic control."

The study involved 143 patients with type 2 diabetes who received diabetes care at 1 of 3 health centers. The inclusion criteria were a diagnosis of type 2 diabetes at least 1 year previously and glycated hemoglobin (HbA_1c) levels exceeding 10% (86 mmol/mol) in the previous year.

During an initial interview, clinicians trained in care planning helped each patient develop an individualized management plan. Clinicians also assessed patients' knowledge of diabetes and informed them why they need improved glycemic control.

Six months after a management plan was developed, 97 patients (75.8%) exhibited improved glycemic control and 70 (54.6%) exhibited at least a 1% improvement in HbA_1c levels.

Over the course of the patient interviews, the investigators identified a number of common causes of poor glycemic control, including problems with therapy, poor patient engagement or knowledge of diabetes, psychosocial or mental health issues, and occupational issues. Many patients had multiple causes of poor glycemic control.

"Whilst the reasons for poor glycemic control are frequently complex and multifactorial, the study suggests that focusing on these reasons and working in partnership with patients can lead to significant improvements in glycemic control," the authors write.

However, they caution against drawing any definitive conclusions at this time. "Whilst theoretically, care planning is more patient focused, there are as yet no randomized data to suggest it has an impact on improving glycemic control," the authors state. "Our study was not designed to [compare] the approach...to a standard approach, and it is impossible to say whether similar improvements in control would have been seen with a standard approach."

Prim Care Diabetes. Nov. 2011;5:251-255.  The study, by Hamida Khan, MD, and colleagues from the London School of Medicine and Dentistry, in the United Kingdom, was published in the December issue of Primary Care Diabetes.