OBJECTIVE: To assess the effectiveness of the management of type 2 diabetes in an urban Australian setting. DESIGN AND SETTING: The Fremantle Diabetes Study (FDS), a community-based longitudinal observational study. PATIENTS: 531 FDS participants with type 2 diabetes, with mean age, 62.4 years (95% CI, 40.9-79.3 years), 54% male, median diabetes duration 3.0 years (interquartile range [IQR], 0.7-7.0 years), with valid data from the baseline FDS assessment and five subsequent annual reviews between 1993 and 2001. MAIN OUTCOME MEASURES: Glycated haemoglobin (HbA(1c)) levels at annual review visits before and after change in blood glucose-lowering therapy. RESULTS: Over 2893 patient-years of follow-up, 97 patients (18%) progressed from dietary management to therapy with oral hypoglycaemic agents (OHA), and 45 (9%) progressed from OHA to insulin therapy, after a median duration of diabetes of 4.0 years (IQR, 2.9-5.5 years) and 8.1 years (IQR, 5.5-13.0 years), respectively. Median HbA(1c) concentrations (IQR) at the review before OHA or insulin were started were 7.7% (6.9%-8.8%) and 9.4% (8.0%-10.7%), respectively. At the next annual review, HbA(1c) levels in the two groups had fallen to 7.4% (6.5%-8.1%) and 7.9% (7.2%-9.5%), respectively (P < or = 0.001). Intensification of therapy was associated with beneficial changes in serum lipid profiles, but not with an increase in frequency of hypoglycaemia. CONCLUSIONS: Most Australian patients with type 2 diabetes may be spending most of the duration of their disease with suboptimal glycaemic control (HbA(1c) > 7.0%), despite the availability of a range of effective therapies, including insulin.
OBJECTIVE: To assess the effectiveness of the management of type 2 diabetes in an urban Australian setting. DESIGN AND SETTING: The Fremantle Diabetes Study (FDS), a community-based longitudinal observational study. PATIENTS: 531 FDS participants with type 2 diabetes, with mean age, 62.4 years (95% CI, 40.9-79.3 years), 54% male, median diabetes duration 3.0 years (interquartile range [IQR], 0.7-7.0 years), with valid data from the baseline FDS assessment and five subsequent annual reviews between 1993 and 2001. MAIN OUTCOME MEASURES: Glycated haemoglobin (HbA(1c)) levels at annual review visits before and after change in blood glucose-lowering therapy. RESULTS: Over 2893 patient-years of follow-up, 97 patients (18%) progressed from dietary management to therapy with oral hypoglycaemic agents (OHA), and 45 (9%) progressed from OHA to insulin therapy, after a median duration of diabetes of 4.0 years (IQR, 2.9-5.5 years) and 8.1 years (IQR, 5.5-13.0 years), respectively. Median HbA(1c) concentrations (IQR) at the review before OHA or insulin were started were 7.7% (6.9%-8.8%) and 9.4% (8.0%-10.7%), respectively. At the next annual review, HbA(1c) levels in the two groups had fallen to 7.4% (6.5%-8.1%) and 7.9% (7.2%-9.5%), respectively (P < or = 0.001). Intensification of therapy was associated with beneficial changes in serum lipid profiles, but not with an increase in frequency of hypoglycaemia. CONCLUSIONS: Most Australian patients with type 2 diabetes may be spending most of the duration of their disease with suboptimal glycaemic control (HbA(1c) > 7.0%), despite the availability of a range of effective therapies, including insulin.
Authors: D G Bruce; G Casey; W A Davis; S E Starkstein; R C Clarnette; J K Foster; F J Ives; O P Almeida; T M E Davis Journal: Diabetologia Date: 2006-10-13 Impact factor: 10.122
Authors: James D Best; Paul L Drury; Timothy M E Davis; Marja-Riitta Taskinen; Y Antero Kesäniemi; Russell Scott; Christopher Pardy; Merryn Voysey; Anthony C Keech Journal: Diabetes Care Date: 2012-03-19 Impact factor: 19.112
Authors: Agnes I Vitry; Elizabeth E Roughead; Adrian K Preiss; Philip Ryan; Emmae N Ramsay; Andrew L Gilbert; Gillian E Caughey; Sepehr Shakib; Adrian Esterman; Ying Zhang; Robyn A McDermott Journal: PLoS One Date: 2010-11-17 Impact factor: 3.240
Authors: Louise J Maple-Brown; Joan Cunningham; Bernard Zinman; Mary Mamakeesick; Stewart B Harris; Philip W Connelly; Jonathan Shaw; Kerin O'Dea; Anthony J Hanley Journal: Cardiovasc Diabetol Date: 2012-03-28 Impact factor: 9.951
Authors: Barbara Schmidt; Mark Wenitong; Adrian Esterman; Wendy Hoy; Leonie Segal; Sean Taylor; Cilla Preece; Alex Sticpewich; Robyn McDermott Journal: BMC Public Health Date: 2012-11-21 Impact factor: 3.295
Authors: John S Furler; Doris Young; James Best; Elizabeth Patterson; David O'Neal; Danny Liew; Jane Speight; Leonie Segal; Carl May; Jo-Anne Manski-Nankervis; Elizabeth Holmes-Truscott; Louise Ginnivan; Irene D Blackberry Journal: Implement Sci Date: 2014-02-14 Impact factor: 7.327