Prevalence, care, and outcomes for patients with diet-controlled diabetes in general practice: cross sectional survey

Abstract

Background: Tight glycaemic control reduces microvascular complications in patients with type 1 and type 2 diabetes. We aimed to establish the proportion with type 2 diabetes treated through diet only and to determine levels of complications and quality of care received compared with patients on hypoglycaemic medication.

Methods: We undertook a cross-sectional study of 7870 patients with type 2 diabetes from a population of 253,618 patients from 42 general practices in the UK. Our primary outcome was process of care measures and diabetes-related complications.

Findings: 31.3% of all patients with type 2 diabetes are being managed with diet only (1% of the total population). More than four-fold variation between practices exists (range 15.6-73.2%). Patients treated with diet only are much less likely to have HbA1c (glycosylated haemoglobin) measurements, blood pressure, cholesterol, smoking, microalbuminuria testing, or screening for foot pulses recorded. 38.4% of patients with type 2 diabetes on medication have a HbA(1c) above 7.5% compared with 17.3% of those treated with diet only. Compared with those on medication, patients treated by diet only are more likely to have raised blood pressure and less likely to be on anti-hypertensive medication; they are 45% more likely to have raised cholesterol and less likely to be prescribed lipid-lowering medication. Although fewer of those treated by diet (68%) have diabetes-related complications compared with those on medication (80%), the rate is much higher than for the population without diabetes.

Interpretation: Diabetics treated by diet only have significant rates of complications and are less likely than those on medication to be adequately monitored. There is great scope for improved management within general practice.