Treatment of Hyperglycaemia in Type 2 Diabetic Patients in a Primary Care Population Database in a Mediterranean Area (Catalonia, Spain)

Abstract

Methods: A cross-sectional survey of 286,791 patients with type 2 diabetes registered in the primary care centres of the Catalan Health Institute (Catalonia, Spain) in 2009. We analysed the effects of types of treatment, diabetes duration and renal function on glycaemic control, adjusting for other clinical variables. Results: Twenty-four percent of patients were treated with lifestyle changes only, 35.5% with oral glucoselowering monotherapy, 21% with oral combinations and 17.7% with insulin (alone or in combination). Insulin was more frequently used in patients with longer duration of diabetes or severe renal impairment. Fifty-six percent of patients achieved the optimal target of HbA1c ≤ 7% (≤ 53 mmol/mol), a result more frequently observed in patients older than 65, early in the course of the disease and at the lower steps of treatment (p<0.001). Impaired renal function was present in 18.4% of patients. A significant number of patients with severe renal impairment were taking metformin (16.2%) or sulfonylureas (12.1%), which are contraindicated at this stage. Multivariable analyses confirmed that lower steps of treatment, advanced age and lesser years of diabetes duration were the variables positively related to good glycaemic control. Conclusions: Glycaemic control deteriorates with the progression of the disease despite the treatment intensification. Impaired renal function was frequent and a remarkable proportion of these patients were taking contraindicated drugs.