Abstract
Glycemic and body weight control are two outstanding goals in the treatment of patients with type 2 diabetes that often are not appropriately achieved. This observational study evaluates whether treatment by quality controlled diabetes centers generates an improvement in this regard and focuses on associations with different therapies. Data of 9.294 type 2 diabetic patients (mean age 66.9±11.6 years, mean diabetes duration 12.4±9.2 years) from 103 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database). Therapeutic concepts included lifestyle intervention (n=1.813), oral antidiabetics (OAD, n=1.536), insulin (n=4.504) and insulin plus OAD (n=1.441). HbA1c and body weight were compared before and after a stable therapeutical period of 1.07±0.3 years. Change in HbA1c (%): all patients 7.4±1.6–7.0±1.3, lifestyle intervention 7.5±1.9–6.9±1.5, OAD 6.7±1.1–6.5±1.0, insulin 7.6±1.6–7.2±1.4, insulin plus OAD 7.5±1.5–7.2±1.3; each p≤0.05. Change in body weight (kg): all patients +0.08±0.07, n. s.; lifestyle intervention −0.28±0.20, OAD −0.56±0.13, each p<0.05 [metfomin −0.77±0.21, sulfonylurea drugs −0.75±0.34, each p<0.05; glitazones +0.62±0.70, α-glucosidase inhibitors −0.22±0.76, each n. s.], insulin +0.27±0.10, insulin plus OAD +0.63±0.14, each n. s. In summary, lifestyle, metformin or sulfonylurea drug treatment resulted in HbA1c-values below 7.0% plus a significant weight reduction. Insulin treatment-associated concepts resulted in HbA1c-values slightly above 7.0% without body weight alterations. These “real life” data underline that a specialised and quality controlled diabetes care is able to achieve significant treatment results even in patients with disease progression and a high proportion of insulin therapies.
Key words
diabetes treatment - obesity - glycemic control - quality management
References
1
Action to Control Cardiovascular Risk in Diabetes Study Group,
.
Gerstein HC, Miller ME, Byington RP. et al .
Effects of intensive glucose lowering in type 2 diabetes.
N Engl J Med.
2008;
358
2545-2559
2
ADVANCE Collaborative Group,
.
Patel A, MacMahon S, Chalmers J. et al .
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
N Engl J Med.
2008;
358
2560-2572
3
American Diabetes Association Standards of Medical Care in Diabetes – 2007
.
Diabetes Care.
2007;
30
((Suppl. 1))
S4-S41
4
Barnett A, Allsworth J, Jameson K. et al .
A review of the effects of antihyperglycaemic agents on body weight: the potential of incretin targeted therapies.
Curr Res Med Opin.
2007;
23
1493-1507
5
Buchwald H, Estok R, Fahrbach K. et al .
Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis.
Am J Med.
2009;
122
248-256
6
Després JP, Lemieux I, Prud'homme D.
Treatment of obesity: need to focus on high risk abdominally obese patients.
BMJ.
2001;
322
716-720
7
Fontaine KR, Redden DT, Wang C. et al .
Years of life lost due to obesity.
JAMA.
2003;
289
187-193
8
Golay A.
The metformin and body weight.
Int J Obes.
2008;
32
61-72
9
Harris SB, Worrall G, Macaulay A. et al .
Diabetes Management in Canada: Baseline Results of the Group Practice Diabetes Management Study.
Can J Diabetes.
2006;
30
131-137
10
Harris TB, Savage PJ, Tell GS. et al .
Carrying the burden of cardiovascular risk in old age: associations of weight and weight change with prevalent cardiovascular disease, risk factors, and health status in the Cardiovascular Health Study.
Am J Clin Nutr.
1997;
66
837-844
11
Heiat A, Vaccarino V, Krumholz HM.
An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons.
Arch Intern Med.
2001;
161
1194-1203
12
Herbst A, Kordonouri O, Schwab K. et al .
Impact of physical activity on cardiovascular risk factors in children with type 1 diabetes: a multicenter study of 18 392 patients.
Diabetes Care.
2007;
30
203-209
13
Howard BV, Best LG, Galloway JM. et al .
Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors.
Diabetes Care.
2006;
29
391-397
14
Huppertz E, Pieper L, Klotsche J. et al .
Diabetes mellitus in German primary care: quality of glycaemic control and subpopulations not well controlled – results of the DETECT study.
Exp Clin Endocrinol Diabetes.
2009;
117
6-14
15
IDF Clinical Guidelines Task Force Global guideline for type 2 diabetes
.
International Diabetes Federation.
2005;
Brussels
16
Liebl A, Neiss A, Spannheimer A. et al .
Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus patients in Germany – results from the CODE-2 study.
Dtsch Med Wochenschr.
2001;
126
585-589
17
McGill Jr HC, McMahan CA, Herderick EE. et al .
Obesity accelerates the progression of coronary atherosclerosis in young men.
Circulation.
2002;
105
2712-2718
18
Narayan KM, Boyle JP, Thompson TJ. et al .
Lifetime risk for diabetes mellitus in the United States.
JAMA.
2003;
290
1884-1890
19
Norris SL, Engelgau MM, Narayan KMV.
Effectiveness of self-management training in type 2 diabetes.
Diabetes Care.
2001;
24
561-587
20
Prospective Studies Collaboration.
.
Whitlock G, Lewington S, Sherliker P. et al .
Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.
Lancet.
2009;
373
1083-1096
21
Ray KK, Seshasai SR, Wijesuriya S. et al .
Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials.
Lancet.
2009;
373
1765-1772
22
Rihl J, Biermann E, Standl E.
Insulin resistance and type 2 diabetes: the IRIS-study.
Diabetes und Stoffwechsel.
2002;
11
150-158
23
Rosen ED, Spiegelman BM.
Adipocytes as regulators of energy balance and glucose homeostasis.
Nature.
2006;
444
847-853
24
Saaddine JB, Cadwell B, Gregg EW. et al .
Improvement in diabetes processes of CARE and intermediate outcomes: United States, 1988–2002.
Ann Intern Med.
2006;
144
465-474
25
Schramm TK, Gislason GH, Køber L. et al .
Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people.
Circulation.
2008;
117
1945-1954
26
Schütt M, Kern W, Krause U. et al .
for the DPV initiative Is the frequency of self blood glucose measurements related to longterm metabolic control? Multicenter analysis including 24 500 patients from 191 centers in Germany and Austria.
Exp Clin Endocrinol Diabetes.
2006;
114
384-388
27
Selvin E, Bolen S, Yeh HC. et al .
Cardiovascular outcomes in trials of oral diabetes medications.
Arch Intern Med.
2008;
168
2070-2080
28
The Diabetes Control and Complications Trial Research Group.
.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
N Engl J Med.
1993;
329
977-986
29
UK Prospective Diabetes Study (UKPDS) Group.
.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet.
1998;
352
837-853
Correspondence
Priv. Doz. Dr. M. Schütt
Department of Internal Medicine I
University Hospital of Schleswig-Holstein
Campus Lübeck
23538 Lübeck
Germany
Telefon: +49/0451/500 5971
Fax: +49/0451/500 3339
eMail: morten.schuett@uk-sh.de