Glycaemic control in type 2 diabetes: the impact of body weight, b-cell function and patient education

Summary We examined the determinants of glycaemic control was 0.47×/(2.89 nmol/l and correlated with BMI ( p<0.001). Glycated haemoglobin was correlated in a consecutive cohort of 562 newly-referred Chinese type 2 diabetic patients (57% women) positively with age ( p=0.013), disease duration ( p<0.001), IR ( p<0.001) and negatively with BMI during a 12-month period. All patients underwent a structured assessment with documentation of clin- ( p<0.001). Glycated haemoglobin was lower in patients who had seen a dietitian (7.9% vs. 8.7%, ical and biochemical characteristics. Pancreatic b- cell function was assessed by fasting plasma p<0.001) or diabetes nurse (7.8% vs. 8.7%, p<0.001) or who performed self blood glucose C-peptide concentration. Insulin deficiency was defined as fasting plasma C-peptide <0.2 pmol/ml. monitoring (7.9% vs. 8.6%, p=0.001) and higher among smokers (8.9% vs. 8.2%, p=0.003). Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA) based on a Compared to insulin-deficient patients (n=118), non-insulin-deficient patients (n=413) had features product of fasting plasma glucose and insulin con- centrations. Treatment was considered appropriate resembling that of the Metabolic Syndrome with increased WHR ( p=0.005), blood pressure when insulin-deficient patients were treated with insulin and non-insulin-deficient patients were ( p<0.001), BMI ( p=0.001) and were older ( p= 0.04). Amongst the insulin-deficient patients, 27% treated with oral agents or diet. Mean (±SD) age was 54.3±13.8 years (range 17-87 years) and dis- were treated with oral agents or diet. Patients receiving appropriate therapy (n=362) had a lower ease duration was 5.0±5.9 years. At the time of referral, 70.5% (n=396) were on drug therapy (9% HbA lc than those treated inappropriately (n=173) (8.2% vs. 8.7%, p=0.02). On multivariate analysis, on insulin and 62.8% on oral agents), 20.6% (n= 116) were on diet and 9% (n=50) had not received short disease duration ( p<0.001), low IR ( p<0.001), high BMI ( p=0.001), diabetes educa- any form of treatment. The mean HbA lc was 8.4±2.3%. The geometric mean (×/( antilog SD) tion ( p<0.001), lack of smoking (p=0.014) and choice of appropriate treatment ( p=0.009) were