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(2005)
26 Quality and Outcomes Framework Information. NHS Health and Social Care Information Centre
J. Wofford (2002)
Clinical inertia.Annals of internal medicine, 137 6
F Harrell, Kerry Lee, D. Mark (2005)
Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors
A. Newnham, R. Ryan, K. Khunti, A. Majeed (2002)
Prevalence of diagnosed diabetes mellitus in general practice in England and Wales, 1994 to 1998
(2005)
Multivariable prognostic models
(2004)
cemic control continues to deteriorate after sulfonylureas are added to metformin among patients with type 2 diabetes
J. Hippisley-Cox, S. O’Hanlon, C. Coupland (2004)
Association of deprivation, ethnicity, and sex with quality indicators for diabetes: population based survey of 53 000 patients in primary careBMJ : British Medical Journal, 329
R. Turner, C. Cull, V. Frighi, R. Holman (1999)
Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group.JAMA, 281 21
(2003)
Developing a large elec
B. Shah, J. Hux, A. Laupacis, B. Zinman, C. Walraven (2005)
Clinical inertia in response to inadequate glycemic control: do specialists differ from primary care physicians?Diabetes care, 28 3
Michael Cook, C. Girman, P. Stein, C. Alexander, R. Holman (2005)
Glycemic control continues to deteriorate after sulfonylureas are added to metformin among patients with type 2 diabetes.Diabetes care, 28 5
Uk-Prospective-Diabetes-Study-Group (1998)
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 352
A. Bagust, P. Hopkinson, L. Maslove, C. Currie (2002)
The projected health care burden of Type 2 diabetes in the UK from 2000 to 2060Diabetic Medicine, 19
Patricia Smith (1979)
Splines as a Useful and Convenient Statistical ToolThe American Statistician, 33
L. Jørgensen, P. Petersen, L. Heickendorff, H. Møller, J. Hendel, C. Christensen, A. Schmitz, B. Reinholdt, E. Lund, N. Christensen, E. Hansen, Jens Hastrup, H. Skjødt, E. Eriksen, I. Brandslund (2005)
Glycemic control in diabetes in three Danish countiesClinical Chemistry and Laboratory Medicine (CCLM), 43
G. Auleley, M. Dematons, P. Berchery, F. Raynal-Minville, F. Suarez, B. Heuls-Bernin, C. Blum-Boisgard (2002)
Type 2 diabetes mellitus among beneficiaries of the french national health insurance for self-employed workers (AMPI): comparison of the management of craftsmen or tradesmen with professionals patients.Diabetes & metabolism, 28 6 Pt 1
(2002)
Coronary heart disease and risk
(2002)
London: National Institute for Clinical Excellence
8 National Institute for Clinical Excellence. Management of Type 2 Diabetes
H. Akaike (1974)
A new look at the statistical model identificationIEEE Transactions on Automatic Control, 19
Jeremy Gray, D. Orr, A. Majeed (2003)
Use of Read codes in diabetes management in a south London primary care group: implications for establishing disease registersBMJ : British Medical Journal, 326
I. Carey, D. Cook, S. Wilde, S. Bremner, N. Richards, Steve Caine, D. Strachan, S. Hilton (2003)
Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD)BMC Family Practice, 4
(2003)
The electronic patient
J. Hippisley-Cox, M. Pringle, Ruth Cater, A. Wynn, V. Hammersley, C. Coupland, R. Hapgood, P. Horsfield, S. Teasdale, Christine Johnson (2003)
The electronic patient record in primary care—regression or progression? A cross sectional studyBMJ : British Medical Journal, 326
Jonathan Brown, G. Nichols (2003)
Slow response to loss of glycemic control in type 2 diabetes mellitus.The American journal of managed care, 9 3
(2002)
Clinical inertia.Ann Intern
J. Hippisley-Cox, M. Pringle (2004)
Prevalence, care, and outcomes for patients with diet-controlled diabetes in general practice: cross sectional surveyThe Lancet, 364
L. Donnelly, A. Doney, A. Hattersley, Andrew Morris, E. Pearson (2006)
The effect of obesity on glycaemic response to metformin or sulphonylureas in Type 2 diabetesDiabetic Medicine, 23
C. Currie, D. Kraus, C. Morgan, L. Gill, N. Stott, J. Peters (1997)
NHS acute sector expenditure for diabetes: the present, future, and excess in‐patient cost of careDiabetic Medicine, 14
(2005)
Quality of morbidity coding
K. Jordan, M. Porcheret, P. Croft (2004)
Quality of morbidity coding in general practice computerized medical records: a systematic review.Family practice, 21 4
(1999)
Variations in patients’ adherence
(1974)
Association of depriva
I. Arend, R. Stolk, H.M.J Krans, D. Grobbee, A.J.P Schrijvers (2000)
Management of type 2 diabetes: a challenge for patient and physician.Patient education and counseling, 40 2
P. Clarke, A. Gray, A. Briggs, R. Stevens, D. Matthews, R. Holman, on Study (2005)
Cost-utility analyses of intensive blood glucose and tight blood pressure control in type 2 diabetes (UKPDS 72)Diabetologia, 48
R. Turner, H. Millns, Rury Holman (1997)
Coronary heart disease and risk factors in NIDDM – experience from the United Kingdom Prospective Diabetes StudyDiabetologia, 40
R. Turner, C. Fox, Matthews, H. Mcelroy, C. Cull, R. Holman, P. Neil, D. Hadden, D. Wright, É. Manley, I. Stratton, Uk Diabetes, E. Kohner, Frighi, Michael Gnant (1998)
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group.The Lancet
Simon Lusignan, C. Sismanidis, I. Carey, S. DeWilde, N. Richards, D. Cook (2005)
Trends in the prevalence and management of diagnosed type 2 diabetes 1994–2001 in England and WalesBMC Family Practice, 6
I. Carey, D. Cook, S. Wilde, S. Bremner, N. Richards, Steve Caine, D. Strachan, S. Hilton (2004)
Developing a large electronic primary care database (Doctors' Independent Network) for researchInternational journal of medical informatics, 73 5
(2005)
16 NHS Connecting for Health Read Codes
(2001)
Prevalence, care, and outcomes
K. Khunti, Sumita Ganguli (2000)
Who looks after people with diabetes: Primary or secondary care?Journal of the Royal Society of Medicine, 93
M. Dimatteo (2004)
Variations in Patients’ Adherence to Medical Recommendations: A Quantitative Review of 50 Years of ResearchMedical Care, 42
Background. Type 2 diabetes is common, largely managed in primary care and requires effective glycaemic control to reduce the risk of microvascular complications. Oral hypoglycaemic agents are typically the first pharmacological intervention used to improve glycaemic control.Objectives. To evaluate the management of people with type 2 diabetes with oral hypoglycaemic agents in primary care.Methods. This retrospective cohort study included people with type 2 diabetes treated with oral agents drawn from 243 general practices in the UK over a 5-year study period from 1999 to 2003. Primary outcome measures were glycaemic monitoring and control on oral hypoglycaemic agents.Results. Of the 71561 patients identified with prevalent type 2 diabetes, 20922 received their first prescription for an oral hypoglycaemic agent during the study. Only 49% of patients had a recorded HbA1c within 6 months of starting therapy. Forty per cent of patients had poor glycaemic control (HbA1c7.5%) after starting a single hypoglycaemic agent. There was a statistically significant association between post-therapy HbA1c with pre-therapy HbA1c, metformin dose, age and geodemographical classification. Greater reductions in HbA1c were observed in older patients, those with a high pre-treatment HbA1c and those from less-deprived areas. Patients remained on a single therapy for a median of 3.8 years. During the study, 7009 of those who started a single agent were prescribed a second agent. Of those with a recorded HbA1c, 50% had poor glycaemic control (HbA1c7.5%) post-therapy.Conclusions. Management of type 2 diabetes with oral hypoglycaemic agents appears to be suboptimal for many patients. Oral treatment is often not started until glycaemic control is poor, and many patients do not receive adequate monitoring or have poor glycaemic control following treatment with oral agents. Many patients with a high pre-treatment HbA1c are not controlled on a single oral agent even at high dose suggesting that earlier, more aggressive treatment in primary care is required.
Family Practice – Oxford University Press
Published: May 7, 2007
Keywords: Diabetes mellitus hypoglycaemic agents primary health care
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