CHARACTERISTICS RELATED TO POOR GLYCEMIC CONTROL IN NIDDM PATIENTS INCOMMUNITY PRACTICE

OBJECTIVE - To identify clinical characteristics related to poor glyce mic control in patients with NIDDM cared for by Michigan primary care physicians. RESEARCH DESIGN AND METHODS - This study was a cross-secti onal secondary analysis of data from 393 NIDDM patients (mean age, 63 +/- 11 years; 54% female; 92% white) in the 1990-1991 Michigan Diabete s in Communities II Study We evaluated patient demographic, clinical, and physiological characteristics, attitudes toward diabetes, and self -care ability. Logistic regression was used for multivariate evaluatio n of the characteristics of those patients whose glycosylated hemoglob in (normal GHb 4-8%) was in the upper 25% of the study sample (GHb >11 .6%). RESULTS - A high meal-stimulated plasma C-peptide was associated with a lower likelihood of poor control (odds ratio [OR] for highest quartile vs. all others = 0.37; 95% CI 0.23-0.58). Longer time since d iagnosis (OR for each 5 years duration = 1.28; 95% CI 1.07-1.53), poor self-care ability (OR = 1.85; 95% CI 1.27-2.71), and perceived absenc e of dietary recommendations (OR = 2.37; 95% CI 1.11-5.08) were also i ndependently associated with presence in the highest GHb quartile. Cha racteristics that were not significantly related to poor glycemic cont rol included sex, age, obesity, educational level, exercise, self-rate d health status, and pharmacological treatment. CONCLUSIONS - 1) Poor glycemic control may reflect progressive failure of islet function, al though the independent relationships of C-peptide level and time since diagnosis are consistent with concepts of heterogeneous mechanisms un derlying NIDDM. 2) Despite the important relationships of biological c haracteristics of NIDDM to glycemic control, patient attitudes and sel f-care ability may be useful targets for designing management strategi es for certain poorly controlled patients.