Simple Protocol Without Insulin Reduces A1c to Below 7%

A simple flowchart, and relatively minor support by trained facilitators, can improve glycemic control in patients with type 2 diabetes.

A group of researchers led by Dr Alex Goudswaard from the Julius Centre for Health Sciences and Primary Care in the Netherlands, recruited 288 patients with type 2 diabetes and inadequately controlled concentrations of HbA1c. The patients followed a simple protocol designed to help them lower their HbA1c concentrations without insulin treatment. Flowcharts were given to the patients’ general practitioners who checked fasting blood glucose concentrations every 2 weeks and adjusted oral medication according to an algorithm, until a fasting blood glucose concentration of <7.0mmol/L was obtained or the maximum dosages of the oral hypoglycaemic drugs in use were reached. Every 3 weeks, two trained facilitators visited the doctors to check on both doctor and patient compliance.

The researchers found that after an average of 3.3 consultations over 14 weeks, 158 (55%) had achieved HbA1c concentrations < 7% and 51 patients (18%) had concentrations >7%. The remaining 27% of patients did not adhere to the protocol. Overall, mean HbA1c concentrations decreased from 8.7% to 6.7% (p<0.001).

The researchers conclude that a protocol in the form of a simple flowchart, and relatively minor support by trained facilitators, can improve glycaemic control in patients with type 2 diabetes.
Diabetic Medicine 2003;20:540-4