Achieving further glycemic control in type 2 diabetes mellitus

Objectives To identify patients with type 2 diabetes mellitus who were in p oor glycemic control and therapeutic adjustments that might improve control . Design Using electronic pharmacy data, we assigned subjects to 1 of 4 the rapeutic categories. We then identified patients within each category who d id not meet the recommended standard Of glycemic control (glycosylated hemo globin [Hb A(1c)] <.0,08 [<8.0%]) and studied their therapeutic regimens fo r possible improvements. Subjects The subjects were 5,061 members of a larg e group-model health maintenance organization who had type 2 diabetes and 1 2 months of 1997 health plan eligibility. Main outcome measures The dosage of antihyperglycemic agents (sulfonylureas, metformin, and insulin) in rela tion to glycemic control as measured by the Hb A(1c). Results A significant number (n = 1,570 [31.0%]) of persons with type 2 diabetes might improve t heir glycemic control with simple adjustments to their pharmacologic therap y. a Conclusion Busy clinicians with heavy workloads can improve their mana gement of diabetes hy identifying patients whose glycemic control could be improved through a change in medication or simple adjustment in dosage.