Diabetics Treated With Diet Only Have More Complications
Issue219 Item 5

People with diabetes on “diet only” do less monitoring and do not take their diet seriously. General practitioners could do a lot better in their efforts to manage type 2 diabetic patients, say the authors of a study reported in the July 31st issue of The Lancet.

Their cross-sectional study of 7870 patients with type 2 diabetes from 42 general practices showed that 31.3% were being managed with diet only. These patients had less rigorous monitoring than those taking drugs and more problems, such as poor glycemic control and hypertension.

The findings suggest the management strategy of using diet only in type 2 diabetes is still very common, Drs. Julia Hippisley-Cox and Mike Pringle from the University of Nottingham report in the journal.

“We weren’t expecting to find such big differences between patients who are on medication and those on diet-only treatment. I think we were expecting to find the overall monitoring in those two groups to be similar.”

Individuals with type 2 diabetes might be effectively managed by diet only, but there needs to be better routine surveillance and more intensive therapy if glycemic control, blood pressure, or cholesterol are not optimum, the authors point out.

For example, 38.4% of the patients on medication had a A1c score below 7.5%, compared with 17.3% of those treated with diet only.

The researchers also found a four-fold variation between practices in the proportion of patients treated with diet only–ranging from 15% to 74% of patients. This variation “shows the inconsistency of clinical decision-making in this area,” the authors point out.
The implications are all the more serious since many people with diabetes on “diet only” do not take their diet seriously, they continue. Conservative estimates suggest that 1% of Britons have diabetes controlled by diet alone.

“There is clearly considerable scope for improving the care received by these patients,” Drs. Hippisley-Cox and Pringle write.

Clinical trials in recent years have shown the benefits of drug treatment for patients with type 2 diabetes, but sometimes the results of trials “take time to filter through” to clinical practice, Dr. Hippisley-Cox said.

She hopes this report will “encourage GPs to look at patients on diet-only treatment” and reconsider how these patients are being managed. In the long-run, more monitoring of these patients is needed to prevent complications. Lancet 2004;363:423-428