Management of newly diagnosed non-insulin-dependent (type 2) diabetes mellitus: a retrospective audit

Abstract

A retrospective survey of the case records of 130 patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) was performed to asses the effect of 1 year of clinical attendance on blood glucose control, body weight, lipid profile and blood pressure. The mean age of these patients was 63 ± (SE) 0.1 years and 45% were 65 years or older. Body mass index (BMI) was 28.3 ± 0.49 kg m −2 and 72% were overweight or obese. Sixty-seven percent of the patients were hypertensive (WHO criteria). Serum cholesterol was 6.0 ± 0.2 mmol/l, HDL cholesterol 1.0 ± 0.0 mmol/l and triglycerides 3.14 ± 0.29 mmol/l (non-fasting). Seventy-two percent of the patients were managed on diet alone and 23% by diet plus sulphonylurea. The remaining 5% were treated by metformin or a combination of metformin plus sulphonylurea. After one year, glycated haemoglobin (HbA 1) decreased from 10.7 ± 0.3% to 8.2 ± 0.2% ( P < 0.01; normal < 7.5%). The diet and sulphonylurea groups showed similar decreases in HbA 1. Overall there was a small but significant fall in BMI (−0.5 ± 0.2 kg m −2; P < 0.05). However, the diet treated patients showed a significant decrease in BMI (−0.8 ± 0.3 kg m −2; P < 0.01) whilst BMI increased in the sulphonylurea treated group (+0.7 ± 0.2 kg m −2; P < 0.01). Serum lipid concentrations remained unchanged in both groups. The proportion of patients with hypertension remained the same. Hence after one year of clinical attendance, HbA 1 improved but there was minimal change in the associated cardiovascular risk factors. A more aggressive approach to the management may be required, particularly in younger patients.