Attaining UKPDS management targets in type 2 diabetes: failures and difficulties

The UKPDS highlighted the importance of good blood glucose control and tight blood pressure control in patients with type 2 diabetes. We have audited 500 consecutive clinic records from patients with type 2 diabetes attending consultant clinics (hospital) and data from a district diabetic register of 500 type 2 patients attending general practice (community) to determine whether internationally agreed targets of good blood glucose (HbA_1c<7%, using a 'DCCT‐aligned' method) and tight blood pressure (BP) control (BP<140/85) are achieved in patients with type 2 diabetes. The mean HbA_1c was 8.7±1.8 (SD)% (hospital) and 8.2±1.5% (community); 81% (hospital) and 72% (community) patients with a recorded measurement in the last twelve months had an HbA_1c level>7%; 58% (hospital) and 44% (community) patients had levels>8%. The mean systolic blood pressure (SBP) was 151±25 mmHg (hospital) and 151±20 mmHg (community); the mean diastolic blood pressure (DPB) was 77±13mmHg (hospital) and 83±11mmHg (community), 68% (hospital) and 66% (community) had at least one measurement above 140/85, of which 45% (hospital) and 49% (community) patients were not prescribed any anti‐hypertensive medication. Guideline targets, particularly with regard to glycaemic and blood pressure control are not achieved in a high proportion of diabetic patients. The problem is similar in both hospital and community‐based care; in many patients, simple adjustments of medication may be all that is required to achieve better control of BP and glucose. However, it is recognised that this will be more difficult in some patients, and may require increased investment in personnel and an increase in prescribing costs. Copyright © 2001 John Wiley & Sons, Ltd.