Management Of Type 2 Diabetes Mellitus Patients Research Articles

Correlations of Serum Lipid Parameters and Atherogenic Indices With Left Ventricular Diastolic Dysfunction Among Apparently Healthy Patients With Type 2 Diabetes Mellitus: A Multicenter In-Hospital Cross-Sectional Study.

Background: In adolescents with Type 1 diabetes, lipid ratios are predictors of left ventricular diastolic dysfunction (LVDD). However, whether this also applies to adults with Type 2 Diabetes Mellitus (T2DM) is unclear. This study is aimed at assessing the correlations of serum lipid parameters and atherogenic indices with LVDD in patients with T2DM. Methods: This cross-sectional study included 203 patients with T2DM aged 59.9 ± 13.6 years (111 males, sex ratio: 1 : 2 in favor of males) from eight randomly selected urban hospitals. Demographic information was collected, an anthropometric assessment was performed, and blood pressure was measured. Fasting blood samples were obtained to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), glucose, and glycated hemoglobin. The atherogenic index of plasma (AIP), Castelli Risk Index I (CRI-I), Castelli Risk Index II (CRI-II), atherogenic coefficient, and non-HDL-C were determined using specific formulas. Diastolic function was assessed using echocardiography as per the 2016 updated guidelines of the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI). Results: Approximately 47.8% of the participants had LVDD. Compared with participants with normal diastolic function, those with LVDD were more likely to be older than 55 years (p < 0.001), tended to have obesity (p = 0.045), had a higher risk of developing dyslipidemia (p = 0.041), and higher AIP and CRI-II (p < 0.05) levels while having similar low HDL-C and hypertriglyceridemia frequencies. In the multivariate model adjusting for age, high AIP (adjusted odds ratio [aOR], 3.37; 95% confidence interval [CI], 1.22-5.34) and high CRI-II (aOR: 3.80; 95% CI: 2.25-6.35) were independent determinants of LVDD. Conclusions: These results highlight the importance of considering atherogenic indices, primarily AIP and CRI-II in the management of T2DM patients. High AIP and high CRI-II could serve as surrogate markers of LVDD, an early cardiovascular manifestation in patients with T2DM.

Real-World Analysis of Rapid-Acting Insulin Analog Use and Its Blood Glucose Lowering Effect in Patients with Type 2 Diabetes Mellitus: Results from PASSION Disease Registry in Korea.

PurposeAlthough rapid-acting insulins (RAIs) are used frequently in Korean clinical settings, evidence on their use is limited. This study explores the pattern and clinical effectiveness of the use of RAIs in Korean patients with type 2 diabetes mellitus (T2DM).Patients and MethodsThis non-interventional, observational study enrolled patients (aged >18 years) with T2DM who were prescribed RAIs. The pattern of use and effectiveness of RAI analogs were evaluated over 6 months.ResultsA total of 299/451 patients were analyzed. Approximately 90% (n/N=270/299) of the patients received insulin glulisine, which significantly reduced their levels of glycated hemoglobin (HbA1c: n=270, mean± standard deviation [SD]; −1.16±6.02%, p=0.0017), fasting plasma glucose (n=40; mean±SD: −54.9±90.89 mg/dl, p=0.0005), and post prandial blood glucose (n=35, mean±SD: −89.46± 105.68 mg/dl, p<0.0001) at 6 months, with a corresponding increase in body weight (BW) (n=197, mean±SD:1.45±3.64 kg, p<0.0001). At 6 months, more patients receiving an intensive regimen (basal insulin+≥2 RAI injections/day) had HbA1c <7% than those receiving a non-intensive regimen (basal insulin+1 RAI injection/day) (20.69% vs 7.46%; p=0.0333); the corresponding reduction in HbA1c was also higher in patients receiving the intensive regimen (p<0.0001). About one-fourth patients (n/N=22/95) were switched to the intensive regimen (from 1 to ≥2 RAI injections/day), and only 4.41% (n/N=9/204) of the patients were switched to 1 RAI injection/day. The patients receiving the intensive regimen showed higher levels of HbA1c reductions (mean±SD: −1.27±1.96%) compared with the maintenance group-1 RAI injection/day (mean±SD: −0.72±1.66%) (p=0.0459), without a significant increase in BW and body mass index.ConclusionThe insulin glulisine intensification regimen showed glycemic target achievement and can be considered a therapeutic tool in the management of T2DM patients.

Socio-Demographic Profile, Asymptomatic Malaria Parasitaemia and Glycemic Control among Midled-Aged and Elderly Type 2 Diabetes Mellitus Patients in Rural Southwestern Nigeria: A Cross Sectional Study

The main therapeutic goal for all type 2 diabetes mellitus (T2DM) patients is to maintain good control so as to prevent the risk of complications associated with poor control. This study determined the prevalence of poor control and its association with socio-demographics and malaria parasitaemia among middle aged and elderly T2DM patients at a tertiary hospital in rural Southwestern Nigeria. We conducted a retrospective observational study on 250 T2DM using semi-structured interviewer administered questionnaire. Venous blood samples were collected and processed for glycated hemoglobin sugar estimation and malaria parasite detection by microscopy. Data were analyzed using SPSS version 20.0. Multivariate logistic regression identified the association of socio-demographics and asymptomatic malaria parasitaemia with poor control. The prevalence of poor glycemic control was 31.6% (95%CI: 34.4%-45.8%). Old age, (AOR=4.868; 95% CI: 1.258-24.574), female genders (AOR=7.100; 95% CI: 1.875-34.655), no formal education (AOR=3.447; 95% CI: 1.098-21.478), presence of malaria parasitaemia (AOR=48.423; 95% CI: 4.987-411.366), and higher parasite density (AOR=7.102; 95% CI: 1.785-15.002), were significantly associated with poor control. Health facilities should integrate screening of malaria parasitaemia into the management of T2DM patients while also exploring other barriers of poor control.

Prognostic nutritional index as a novel marker for diabetic retinopathy in individuals with type 2 diabetes mellitus.

PURPOSE:In recent years, the prognostic nutritional index (PNI), an easily obtainable nutritional inflammatory marker, has been introduced as an independent prognostic indicator for various types of cancers and cardiovascular diseases. However, its clinical importance in the area of ophthalmology is not well known yet. We aimed to elucidate the association between the PNI and the occurrence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).METHODS:In this cross-sectional study, the PNI was applied to 128 consecutive patients with T2DM. The relationship between the PNI and the occurrence of DR was examined. PNI was calculated as 10× (serum albumin) + 0.005 × (total lymphocyte count). The risk factors for DR were evaluated using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve analysis of PNI for predicting DR was performed.RESULTS:Patients with DR had significantly lower levels of PNI than those without DR (41.20 ± 4.81 and 44.49 ± 3.10, respectively,P< 0.001). Multivariate regression analysis indicated that PNI, together with the duration of diabetes and creatinine, was an independent factor for DR occurrence (odds ratio, 0.885; 95% confidence interval: 0.735–0.971;P= 0.017). ROC curve analysis revealed that the best cutoff value of PNI was 43 (area under the curve: 0.713; sensitivity: 74%; specificity: 64%).CONCLUSION:A lower PNI value is common among T2DM patients with DR and is strongly associated with the occurrence of DR. The PNI might be a useful biomarker for identifying DR to improve the risk stratification and management of T2DM patients.

Currents Nutritional Practices of Nutritionists in the Management of Type 2 Diabetes Patients at Public Health Centres in Padang, Indonesia.

(1) Background: The interest in nutrition practices and education is slowly gaining traction among Indonesian nutritionists. However, there is a lack of local studies that evaluate nutritional practices, especially in the management of type 2 diabetes (T2DM). This cross-sectional study aimed to determine the nutritional practices among nutritionists and the adequacy of the current practices in the management of Type 2 Diabetes Mellitus (T2DM) patients at the Public Health Clinic in Padang (PHC), Indonesia. (2) Methods: An online survey form was distributed to all the nutritionists (n = 50) involved in the management of T2DM patients in their daily practices at the PHC. Socio-demographic characteristics, the current practice of T2DM, the need for DM nutrition education, and an evaluation questionnaire on the Indonesian Non-Communicable Diseases guideline and the Public Health Centre guideline were captured in the survey. (3) Result: A total of 48 completed survey forms were received, providing a response rate of 96% from the recruited nutritionists. One-third (37.5%) of the respondents counselled between one and ten patients per day. Nearly half (41.7%) conducted a monthly follow-up session for the patients at their respective PHC in the previous three months. Each nutritionist educated five to ten T2DM patients. The most common nutrition education topics delivered included appropriate menus (89.6%) as well as the etiology and symptoms of T2DM (85.5%). Almost all the nutritionists (93.8%) used leaflets and about 35.4% used poster education. Around 70.8% of counseling sessions lasted 30 min and two-thirds (66.7%) of the sessions included nutrition education. Based on the results, about half (52.1%) of them claimed that T2DM patients were reluctant to attend individual nutrition education. One-fifth of them (20.8%) claimed that it was because the T2DM patients were not interested in the tool kits and materials used. (4) Conclusions: T2DM patients are reluctant to attend individual nutrition education due to uninteresting tool kits and materials.

Pengaruh Self-Efficacy Enhancing Intervention Program (SEEIP) Secara Online Terhadap Self-Efficacy Dalam Manajemen Diri Penderita Diabetes Mellitus Tipe II Di Puskesmas Juli I

Objective: The objective of this study was to determine the effect of Self-Efficacy Enhancing Intervention Program (SEEIP) with online method on Self-Efficacy in Self-Management in Type 2 Diabetes Mellitus (T2DM) at Juli I Public Health CentreMethods: This study was a pre-experimental pre-test and post-test with only one group design. The population wasT2DM at Juli I Public Health Center in 2020. The sample size was 22 participants, selected by purposive sampling technique. Diabetes Management Self-Efficacy Scale (DMSES) was used to measure the Self-Efficacy in Self- Management of T2DM patients. Data were analyzed using paired t-testResults: The results of the study showed that the means score of Self- Management of T2DM before receiving SEEIP was 39,00 (SD: 15,455) and 90,23 (SD: 7,571)after receiving the SEEIP. Paired t-test showed that there was a significant difference on Self- Efficacy in Self-Management in T2DM at Juli I Public Health Centre in 2020Conclusion: SEEIP could improve self-efficacy in self-management for Type 2 diabetes mellitus at Juli I Public Health Centre.

Effect of heart rate on left ventricular longitudinal myocardial function in type 2 diabetes mellitus

BackgroundLeft ventricular (LV) longitudinal myocardial dysfunction is considered a marker of preclinical LV dysfunction in patients with type 2 diabetes mellitus (T2DM). High heart rate (HR) is associated with cardiovascular outcomes, but the effect of HR on LV longitudinal myocardial function in T2DM patients is uncertain.MethodsWe studied 192 T2DM patients with preserved LV ejection fraction (LVEF), and 81 age-, sex-, and LVEF-matched healthy volunteers. HR was measured as the average HR during echocardiography, and high HR was defined as resting HR ≥ 70 beats/minute. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS). The predefined cutoff for subclinical LV dysfunction was set at GLS < 18%.ResultsGLS in T2DM patients with high HR was significantly lower than that in T2DM patients with low HR (16.3% ± 4.2% vs. 17.8% ± 2.8%; P = 0.03), whereas GLS in normal subjects with high and low HR was similar (20.3 ± 1.7% vs. 20.3 ± 2.0%; P = 0.99). Multivariable logistic regression analysis showed that high HR (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = 0.01) was independently associated with GLS < 18% in T2DM patients as well as HbA1c, T2DM duration, LVEF, body mass index, and mitral inflow E and mitral e’ annular velocity ratio. One sequential logistic model evaluating the associations between GLS < 18% and clinical variables in T2DM patients showed an improvement with the addition of LVEF and E/e’ (P < 0.001) and a further improvement with the addition of high HR (P < 0.001).ConclusionCompared with normal subjects, resting HR was associated with LV longitudinal myocardial function in asymptomatic T2DM patients with preserved LVEF. Our findings provide new insights on the management of T2DM patients.

Endothelial dysfunction and cardiovascular outcome in asymptomatic patients with type 2 diabetes: A pilot study.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular events, but risk stratification of asymptomatic T2DM patients remains a challenging issue. We conducted a pilot study to assess whether endothelial dysfunction might help identify, among asymptomatic T2DM patients, those at increased risk of cardiovascular events. We studied 61 consecutive T2DM patients with no evidence of cardiovascular disease and no insulin therapy. Endothelial function was assessed by flow-mediated dilation (FMD) of the right brachial artery. The primary endpoint was a combination of major cardiovascular events (MACE: cardiovascular death, acute coronary events, coronary interventions, and acute cerebrovascular accidents). FMD was repeated at follow-up in 48 patients (79%). A total of 10 MACE (16.4%) occurred during a mean follow-up of 48 months, including three acute myocardial infarctions, five coronary revascularizations for stable angina, and two acute ischaemic strokes. FMD at enrolment was lower in patients with compared with patients without MACE (3.78 ± 0.97% vs 4.70 ± 1.33%, respectively; P = .04). No other clinical or laboratory variables (age, diabetes duration, glycated haemoglobin, cardiovascular risk factors, drug therapy, and nitrate-mediated dilation) were associated with MACE. FMD at follow-up was also lower in patients with (n = 10) compared with those without (n = 38) MACE (3.66 ± 1.29 vs 4.85 ± 1.92; P = .006). Our data suggest that assessment of FMD might be helpful to identify patients at increased risk of MACE among individuals with asymptomatic T2DM; accordingly, a large study is warranted to adequately define the clinical utility of FMD assessment in the management of T2DM patients.

Pharmacists Intervention Reduced Drug-Related Problems in the Treatment of Patients with Type 2 Diabetes Mellitus.

BACKGROUND:Type 2 Diabetes Mellitus (T2DM) remains as a global public health problem, including Indonesia due to its continuous increasing prevalence.AIM:To analyze the impact of pharmacist intervention on drug-related problems (DRPs) occurred in the management of patients with T2DM admitted to Tebing Tinggi Hospital (TTH), Indonesia, period March through August 2018.METHODS:This six-month retrospective prospective cohort study evaluated the impact of pharmacist intervention on the occurrence of DRPs in the management of patients with T2DM (n = 45) insured by Social Security Organizing Body in TTH, North Sumatera, Indonesia. The inclusion criteria were T2DM patients with age ≥ 18 years and under treatment of antidiabetic drugs. A questionnaire was used to assess the characteristics of the patients and antidiabetic drugs provided. The incidence of DRPs in groups with usual care for the previous three-month and with pharmacist interventions for the next three-month admissions were analyzed using Pharmaceutical Care Network Europe (PCNE) DRP classification system version 8.01 that consists of 3 primary domains for problems, 8 primary domains for causes, and 5 primary domains (PCNE, 2017) and trustable literatures. The obtained data were analyzed using descriptive statistics and paired t test in the program of Statistical Package for the Social Sciences version 19 (p < 0.05 was considered significant).RESULTS:Most (66.7%) of the patients were female. Their mean age was 61.96 ± 6.45 (years). The three most widely provided drugs were metformin, glimepirid, and gliclazide. Total incidence of DRPs in groups with: usual care, 128; intervention, 39. There was a significant difference between the incidence of DRPs in groups with usual care and intervention, p ≤ 0.001.CONCLUSION:Pharmacist intervention reduced the incidence of DRPs in the management of T2DM patients.

Role of Asymmetric Dimethylarginine and Nitric Oxide in Type 2 Diabetes Mellitus and Its Cardiovascular Complications

AN ENDOGENOUS inhibitor of nitric oxide synthase, asymmetric dimethylarginine (ADMA), is elevated in patients with type 2 diabetes mellitus (T2DM) and has been related to atherosclerotic disease. The study aims at investigating the status of ADMA and nitric oxide (NO) and their possible correlation inpatients with T2DM with and without cardiovascular complicationsin comparison to normalcontrols. Forty patients with T2DM and 20 age, sex and body mass index (BMI)‑matched healthy controls were included in the study. The studied individuals were divided into Group1: healthy controls (n= 20), Group 2: T2DM patients without cardiovascular complications (n= 20) and Group 3: T2DM patients with evidence of cardiovascular complications (n= 20). Serum ADMA levels were determined by enzyme linked Immunosorbent Assay (ELISA). Serum nitric oxide was measured as stable end product, nitrite. Insulin was measured by immunoradiometric method. Serum ADMA levels showed a significant elevation while serum NO levels were significantly reducedin diabetic patients groups in comparison to controls. Diabetic patients with vascular complications showed highly significant increase in ADMA levels and pronounced decrease in NO compared to those without complications. In the group of vascular complications, the ADMA level was positively correlated with postprandial serum glucose and HbA1c, but there was a negative correlation between ADMA levels and NO. ADMA and NO may serve as predictors for future cardiovascular events in T2DM patients. Further studies are required to establish the utility of decreasing ADMA levels or increasing NO in the management of T2DM patients.

Association of body fat mass with left ventricular longitudinal myocardial systolic function in type 2 diabetes mellitus

BackgroundLeft ventricular (LV) longitudinal myocardial systolic dysfunction (LVSD) has been identified in type 2 diabetes mellitus (T2DM) patients, and it should be considered the first marker of a preclinical form of DM-related cardiac dysfunction. Overweight has been postulated to contribute to the development of LVSD in T2DM patients, but the impact of amount of body fat mass on LVSD in T2DM patients remains uncertain. MethodsWe studied 71 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) (all ≥55%) without coronary artery disease. LVSD for T2DM patients with preserved LVEF was identified as global longitudinal strain (GLS) <18%. Body fat mass was measured with a commercially available body composition analyzer (In Body S-10, Biospace, Tokyo, Japan), and corrected by body surface area (BFI: body fat index). ResultsUnivariate logistic regression analysis revealed that body weight, body mass index (BMI), and BFI were all associated with LVSD, whereas multivariate logistic regression analysis showed BFI was the only variable independently associated with LVSD (OR 1.147; 95% CI 1.001–1.314; p = 0.027). For sequential logistic regression models to predict LVSD, clinical variables including age, DM duration, and HbA1c tended to be improved by addition of BMI, but without statistical significance (p = 0.09), while it was significantly improved by addition of BFI (p = 0.047). ConclusionsUsing BFI for the control of body compression by means of a bioelectrical impedance assay is simple and easy-to-use, and this may have clinical implications for better management of T2DM patients with preserved LVEF to prevent future development of DM-related cardiac dysfunction.

Impact of Pharmacist Intervention on Improving the Quality of Life of Patients with Type 2 Diabetes Mellitus.

AIM:To analyse the characteristics, and analyse the impact of pharmacist intervention on quality of life (QOL) outpatients with type 2 diabetes mellitus (T2DM).METHODS:This six-month analytical cohort study was conducted by assessing the patients’ characteristics and their quality of life by distributing a questionnaire, and the 36-Item short form instrument to the patients with T2DM (n = 45) admitted to the Tertiary hospital in Tebing Tinggi. Patients who had mental disorders, HIV-AIDS, liver disease, stage 4 chronic kidney disease, and pregnant women were excluded from the study. The patients’ quality of life was measured before and after interventions and analysed using the paired t-test. All analyses were performed using the Statistical Package for the Social Sciences (SPSS, version 22, Chicago, IL, USA) (p < 0.05 was considered significant).RESULTS:The mean age of the patients was 61.96 ± 6.45 (years). Most (66.7%) of them were females. The mean QOL (in the score) of the patients: before the intervention, 61.07 ± 15.13; after the intervention, 70.15 ± 14.23, there was a significant difference between groups with and without interventions, p < 0.001.CONCLUSION:Active contribution of pharmacists in the management of T2DM patients is urgent and important to improve the patients’ QOL.

Intelligent Internet-based information system optimises diabetes mellitus management in communities.

To evaluate the effect of an intelligent Internet-based information system upon optimising the management of patients diagnosed with type 2 diabetes mellitus (T2DM). In 2015, a T2DM information system was introduced to optimise the management of T2DM patients for 1 year in Fangzhuang community of Beijing, China. A total of 602 T2DM patients who were registered in the health service centre of Fangzhuang community were enrolled based on an isometric sampling technique. The data from 587 patients were used in the final analysis. The intervention effect was subsequently assessed by statistically comparing multiple parameters, such as the prevalence of glycaemic control, standard health management and annual outpatient consultation visits per person, before and after the implementation of the T2DM information system. In 2015, a total of 1668 T2DM patients were newly registered in Fangzhuang community. The glycaemic control rate was calculated as 37.65% in 2014 and significantly elevated up to 62.35% in 2015 ( p < 0.001). After application of the Internet-based information system, the rate of standard health management was increased from 48.04% to 85.01% ( p < 0.001). Among all registered T2DM patients, the annual outpatient consultation visits per person in Fangzhuang community was 24.88% in 2014, considerably decreased to 22.84% in 2015 ( p < 0.001) and declined from 14.59% to 13.66% in general hospitals ( p < 0.05). Application of the T2DM information system optimised the management of T2DM patients in Fangzhuang community and decreased the outpatient numbers in both community and general hospitals, which played a positive role in assisting T2DM patients and their healthcare providers to better manage this chronic illness.

Handgrip and pinch strength changes of type II diabetes mellitus patients following a 12- week strength training programme

The purpose of this study was to establish the efficacy of a 12-week strength training (ST) programme on handgrip and pinch strength in Type 2 Diabetes Mellitus (T2DM) patients in a tertiary health institution in Benin-City. This study was a pre-test, post-test control group design. A total of 36 T2DM patients participated in the study. Handgrip and pinch strength were measured using electronic hand dynamometer (in kg) and mechanical pinch gauge (in kg) respectively prior to and following a 12-week ST programme. Data generated were analyzed using inferential statistics of one way analysis of variance (ANOVA) and the statistical significance was accepted for p value of &lt;0.05.The findings of the study showed that ST programme had significant effects on handgrip and pinch strength of T2DM patients. It was concluded that ST programme can substantially optimize handgrip and pinch strength of patients with T2DM. Therefore, ST programme should be considered a key element in the management of T2DM patients.

Risk Factors Associated with Hypercoagulability in Type 2 Diabetes Mellitus Patients at Ndola Central Hospital Zambia

Background: Thrombosis, attributed to atherosclerosis, is the leading cause of morbidity and mortality in patients with diabetes mellitus. Pathogenesis of atherosclerosis in diabetes mellitus is not entirely clear and conventional risk factors such as smoking, obesity, blood pressure and serum lipids fail to explain fully this excess risk. We set out a cross-sectional study to determine the risk factors and patient attributes that may predispose type 2 Diabetes Mellitus (T2DM) patients to be in hypercoagulable state. Methods: A structured questionnaire was used to capture Age, Sex, duration of diabetes mellitus and knowledge on T2DM of study participants. Body weight and height were also measured and BMI calculated.VWF, Cholesterol, and Glycated haemoglobin were measured in 213 T2DM patients. VWF was used as a proxy marker for hypercoagulability in T2DM patients. Participants with VWF of >2.0 IU/ml plasma concentration were regarded to be in hypercoagulable state. Results: Chi-square analysis revealed that hypercoagulability in T2DM patients was associated with Age (P=0.001), Sex (P=0.000), glycaemic control (P=0.003), duration of diabetes (P=0.000), BMI (P=0.000) and knowledge on type 2 diabetes mellitus (P=0.001). In multivariate analysis after adjusting for confounders, knowledge on T2DM was not independently associated with hypercoagulability AOR being 1.00(CI 95% 0.80-2.20). However Age, sex, glycaemic control, duration of diabetes and BMI were found to be independent r i sk f a c tor s for hypercoagulability in T2DM patients giving AOR of 1.45(95%CI[1.19-3.16]), 4.42 (95% CI [2.77-10.63]), 6.12 (95% CI 2.27-8.36) 5.28(CI 95% 3.01-8.21) and 1.05(95% CI 0.75-2.86) respectively. Conclusion: Age, Sex, poor glycaemic control, duration of diabetes and obesity should be taken into account in the management of T2DM patients as these variables are independent risk factors of hypercoagulability in T2DM patients.

Management of type 2 diabetes mellitus in Greenland, 2008: examining the quality and organization of diabetes care

Objectives. To analyse the management of type 2 diabetes mellitus (T2DM) in Greenland in 2008.Study design. Observational and cross-sectional study, including a review of medical records anddatabases.Methods. Data on adult (>19 years old) T2DM patients were collected from each primary healthcare centre in Greenland. Information was collected about age, gender, HbA1c, blood pressure, blood lipids, and from eye, feet and urine examinations from 15 of the 17 health care districts inGreenland, which represent 90% of the whole adult population of Greenland. Three clinics wereexcluded because of too few patients (only 7). The management of T2DM patients is described andis based on 6 processes and 3 biological indicators.Results. The 12 clinics together performed quite well looking at the monitoring of HbA1c (79%), blood pressure (69%) and blood lipids (83%). However, the screening rates were low within 2years for microalbuminuria (47%), eye (50%) and foot examinations (29%). Great variation in themanagement of the treatment was observed among the clinics. No clinic achieved all the standardssuggested in this paper. Screening for diabetic retinopathy seemed to be implemented, but therecords were not fully updated, whereas screening for microalbuminuria and foot examinationsclearly were not routine in most clinics.Conclusions. The management of type 2 diabetes mellitus is a major task for the heath care systemin Greenland. It is recommended that the implementation of a national strategy based on nationalguidelines, local diabetes registers and feedback to the clinics get underway as soon as possible.