A Desktop Guide for the Management of Non‐insulin‐dependent Diabetes Mellitus (NIDDM): An Update

Alberti, K. G. M. M.; Gries, F. A.; Jervell, J; Krans, H. M. J.

doi:10.1111/j.1464-5491.1994.tb00376.x

Cited by 102 publications

(63 citation statements)

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“…[Diabetologia (1997) Most patients with non-insulin-dependent diabetes mellitus (NIDDM) in particular when managed with diet or oral hypoglycaemic agents, are treated in a primary health care setting. To optimize the treatment of the growing number of NIDDM patients (inter-) national guidelines have been published [1][2][3][4]. However, the wide acceptance of the guidelines by general practitioners (GPs), and their implementation in practice have proved difficult [5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

et al. 1997

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SummaryIn primary care it is difficult to treat the growing number of non-insulin-dependent diabetic (NIDDM) patients according to (inter)national guidelines. A prospective, controlled cohort study was designed to assess the intermediate term (2 years) effect of structured NIDDM care in general practice with and without 'diabetes service' support on glycaemic control, cardiovascular risk factors, general well-being and treatment satisfaction. The 'diabetes service', supervised by a diabetologist, included a patient registration system, consultation facilities of a dietitian and diabetes nurse educator, and protocolized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy. In the study group (SG; 22 general practices), 350 known NIDDM patients over 40 years of age (206 women; mean age 65.3 + SD 11.9; diabetes duration 5.9 + 5.4 years) were followed for 2 years. The control group (CG; 6 general practices) consisted of 68 patients (28 women; age 64.6 + 10.3; diabetes duration 6.3 + 6.4 years). Mean HbAtc (reference 4.3-6.1%) fell from 7.4 to 7.0% in SG and rose from 7.4 to 7.6 % in CG during follow-up (p = 0.004). The percentage of patients with poor control (HbAlc > 8.5 %) shifted from 21.4 to 11.7 % in SG, but from 23.5 to 27.9 % in CG (p = 0.008). Good control (HbAlc < 7.0 %) was achieved in 54.3 % (SG; at entry 43.4%) and 44.1% (CG; at entry 54.4%) (p = 0.013). Insulin therapy was started in 29.7 % (SG) and 8.8 % (CG) of the patients (p = 0.000) with low risk of severe hypoglycaemia (0.019/patient year). Mean levels of total and HDL-cholesterol (SG), triglycerides (SG) and diastolic blood pressure (SG + CG) and the percentage of smokers (SG) declined significantly, 'but the prevalence of these risk factors remained high. General well-being (SG) did not change during intensified therapy. Treatment satisfaction (SG) tended to improve. Implementation of structured care, including education and therapeutic advice, results in sustained good glycaemic control in the majority of NIDDM patients in primary care, with low risk of hypoglycaemia. Lowering cardiovascular risk requires more than reporting results and referral to guidelines. [Diabetologia (1997[Diabetologia ( ) 40: 1334[Diabetologia ( -1340

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Section: Discussionmentioning

confidence: 99%

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

et al. 1997

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“…Characteristics of the MS were defined by the following cutoff limits (34): BMI Ն26 kg/m 2 for women and Ն27 kg/m 2 for men, TC Ն5.2 mmol/l, HDL cholesterol Ͻ0.9 mmol/l for men and Ͻ1.1 mmol/l for women, TG Ն1.7 mmol/l, and uric acid Ն400 µmol/l. Prevalence of diabetes was assessed either by fasting blood glucose levels Ն7.0 mmol/l (35) and/or the reported presence of diabetes and/or treatment with antidiabetic drugs.…”

Section: Statistical Analysesmentioning

confidence: 99%

Association between C-reactive protein and features of the metabolic syndrome: a population-based study.

et al. 2000

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OBJECTIVE -To assess the association of circulating levels of C-reactive protein, a sensitive systemic marker of inflammation, with different components of the metabolic syndrome.RESEARCH DESIGN AND METHODS -Total cholesterol (TC), HDL cholesterol, triglycerides, uric acid, BMI , and prevalence of diabetes and hypertension were assessed in 747 men and 956 women aged 18-89 years who were participating in the population-based National Health and Nutrition Survey, which was carried out in former West Germany in 1987-1988.RESULTS -There was a statistically significant positive crude correlation between C-reactive protein and TC (R = 0.19), TG (R = 0.29), BMI (R = 0.32), glucose (R = 0.11), and uric acid (R = 0.14) (all P Ͻ 0.0001). A negative correlation was found between C-reactive protein and HDL cholesterol (R = 0.13, P Ͻ 0.0001). The age-adjusted geometric means of C-reactive protein concentrations in subjects grouped according to the presence of 0-1, 2-3, and Ն4 features of the metabolic syndrome were 1.11, 1.27, and 2.16 mg/l, respectively, with a statistically highly significant trend (P Ͻ 0.0001).CONCLUSIONS -The data suggest that a variety of features of the metabolic syndrome are associated with a systemic inflammatory response.

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“…Currently, a number of treatment options are available which do not abolish the disease but which can correct the associated metabolic imbalances and prevent long-term complications developing. Optimal management requires consideration of all aspects of the metabolic syndrome, such as obesity, hypertension, lipid disorders and macrovascular disease, in addition to the measures required to achieve adequate glycaemic control [9].…”

Section: Complications and Their Managementmentioning

confidence: 99%

The Cost of Diabetes Type II in Europe The CODE-2 Study

Massi‐Benedetti

2002

Diabetologia

106

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A Desktop Guide for the Management of Non‐insulin‐dependent Diabetes Mellitus (NIDDM): An Update

Cited by 102 publications

References 0 publications

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Association between C-reactive protein and features of the metabolic syndrome: a population-based study.

The Cost of Diabetes Type II in Europe The CODE-2 Study

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