Glycaemic control in the diabetes and Lifestyle Cohort Twente: A cross‐sectional assessment of lifestyle and pharmacological management on Hba1c target achievement

• Published in: Diabetes, obesity & metabolism Vol. 20; no. 10; pp. 2494 - 2499
• Main Authors: Jalving, Annis C., Gant, Christina M., Binnenmars, S. Heleen, Soedamah‐Muthu, Sabita S., Bakker, Stephan J. L., Navis, Gerjan, Laverman, Gozewijn D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2018; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Blood Glucose - drug effects; Blood Glucose - metabolism; Body mass index; Brief Report; Brief Reports; clinical diabetes; Cohort Studies; Cross-Sectional Studies; Data processing; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Drug therapy; Female; Glucose; Glycated Hemoglobin A - drug effects; Glycated Hemoglobin A - metabolism; Hemoglobin; Humans; Insulin; Insulin - therapeutic use; insulin therapy; Life Style; Lifestyles; Male; Middle Aged; nutrition and diet; oral pharmacological agents; Patient Care Planning; Patients; Treatment Outcome; nutrition and diet; insulin therapy; clinical diabetes; oral pharmacological agents
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.13399

The majority of patients with type 2 diabetes do not reach target levels of glycated haemoglobin (HbA1c < 7%). We investigated the prevalence of HbA1c‐target achievement and opportunities afforded by lifestyle and pharmacological treatment to increase target achievement. We performed cross‐sectional analyses of baseline data from the Diabetes and Lifestyle Cohort Twente‐1 (DIALECT‐1). Patients were divided according to (1) HbA1c <53 and ≥53 mmol/mol (<7%) and (2) non‐insulin treatment and tertiles of daily insulin use. We found that 161 (36%) patients achieved the target HbA1c level. Patients with HbA1c ≥53 mmol/mol had a longer duration of diabetes (13 [8‐20] vs 9 [4‐14] years; P < .001) and more frequently were insulin‐users (76% vs 41%, P < .001). Patients in the highest tertile of insulin use had a higher body mass index than those in the lowest tertile (35.8 ± 5.5 vs 29.8 ± 5.5 kg/m2; P < .001). Achievement of target HbA1c is low in this type 2 diabetes population. High resistance to pharmacological treatment, paralleled with high body mass index, illustrates that increasing insulin sensitivity through lifestyle intervention is the best opportunity to improve HbA1c target achievement in this real‐life population.