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Glycaemic control in type 2 diabetes: the impact of body weight, β‐cell function and patient education

W.B. CHAN, J.C.N. CHAN, C.C. CHOW, V.T.F. YEUNG, W.Y. SO, J.K.Y. LI, G.T.C. KO, R.C.W. MA, C.S. COCKRAM
DOI: http://dx.doi.org/10.1093/qjmed/93.3.183 183-190 First published online: 1 March 2000

Abstract

We examined the determinants of glycaemic control in a consecutive cohort of 562 newly‐referred Chinese type 2 diabetic patients (57% women) during a 12‐month period. All patients underwent a structured assessment with documentation of clinical and biochemical characteristics. Pancreatic β‐cell function was assessed by fasting plasma C‐peptide concentration. Insulin deficiency was defined as fasting plasma C‐peptide <0.2 pmol/ml. Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA) based on a product of fasting plasma glucose and insulin concentrations. Treatment was considered appropriate when insulin‐deficient patients were treated with insulin and non‐insulin‐deficient patients were treated with oral agents or diet. Mean (±SD) age was 54.3±13.8 years (range 17–87 years) and disease duration was 5.0±5.9 years. At the time of referral, 70.5% (n=396) were on drug therapy (9% on insulin and 62.8% on oral agents), 20.6% (n=116) were on diet and 9% (n=50) had not received any form of treatment. The mean HbAlc was 8.4±2.3%. The geometric mean (×/÷ antilog SD) of IR was 4.62×/÷2.51 (range 0.63–162.7) and correlated only with waist : hip ratio (WHR, p=0.008). The geometric mean of plasma C peptide was 0.47×/÷2.89 nmol/l and correlated with BMI (p<0.001). Glycated haemoglobin was correlated positively with age (p=0.013), disease duration (p<0.001), IR (p<0.001) and negatively with BMI (p<0.001). Glycated haemoglobin was lower in patients who had seen a dietitian (7.9% vs. 8.7%, p<0.001) or diabetes nurse (7.8% vs. 8.7%, p<0.001) or who performed self blood glucose monitoring (7.9% vs. 8.6%, p=0.001) and higher among smokers (8.9% vs. 8.2%, p=0.003). Compared to insulin‐deficient patients (n=118), non‐insulin‐deficient patients (n=413) had features resembling that of the Metabolic Syndrome with increased WHR (p=0.005), blood pressure (p<0.001), BMI (p=0.001) and were older (p=0.04). Amongst the insulin‐deficient patients, 27% were treated with oral agents or diet. Patients receiving appropriate therapy (n=362) had a lower HbAlc than those treated inappropriately (n=173) (8.2% vs. 8.7%, p=0.02). On multivariate analysis, short disease duration (p<0.001), low IR (p<0.001), high BMI (p=0.001), diabetes education (p<0.001), lack of smoking (p=0.014) and choice of appropriate treatment (p=0.009) were the independent determinants of good glycaemic control.

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