Results of a UK study in this week’s issue of THE LANCET highlight how people with diabetes controlled by diet alone have significant rates of complications and are less likely than patients on medication to be adequately monitored. Authors of the study conclude that there is great scope for the improved care of diabetic patients within UK general practice.
A proportion of people with late-onset (type 2) diabetes use diet to achieve glycaemic control. Although up to 3% of the UK population has diabetes, there is little research from primary care about the degree of complications experienced and the quality of care received for people with diabetes controlled by diet compared with people receiving medication for diabetes.
Julia Hippisley-Cox and Mike Pringle (University of Nottingham, UK) did a cross-sectional study of 7870 patients with type 2 diabetes from a population of over a quarter of a million patients from 42 UK general practices. They report how just under a third (31%) of all patients with type 2 diabetes are being managed by diet only, although the proportion of such patients varied substantially across the practices studied (15–75%).
People with type 2 diabetes managed by diet only received less monitoring for blood pressure, cholesterol, and other risk factors associated with diabetes. Compared with diabetic patients receiving medication, patients on diet management were more likely to have raised blood pressure and less likely to be on medication to reduce hypetension; they were 45% more likely to have raised cholesterol and less likely to be prescribed lipid-lowering medication. Although fewer of those treated by diet (68%) had diabetes-related complications compared with those on medication (80%), the rate was much higher than for the general population.