Under a third (31%) of all patients with type 2 diabetes are being managed by diet only

Results of a UK study in this week’s issue of THE LANCET highlight how people with diabetes controlled by diet alone have significant rates of complications and are less likely than patients on medication to be adequately monitored. Authors of the study conclude that there is great scope for the improved care of diabetic patients within UK general practice.

A proportion of people with late-onset (type 2) diabetes use diet to achieve glycaemic control. Although up to 3% of the UK population has diabetes, there is little research from primary care about the degree of complications experienced and the quality of care received for people with diabetes controlled by diet compared with people receiving medication for diabetes.

Julia Hippisley-Cox and Mike Pringle (University of Nottingham, UK) did a cross-sectional study of 7870 patients with type 2 diabetes from a population of over a quarter of a million patients from 42 UK general practices. They report how just under a third (31%) of all patients with type 2 diabetes are being managed by diet only, although the proportion of such patients varied substantially across the practices studied (15–75%).

People with type 2 diabetes managed by diet only received less monitoring for blood pressure, cholesterol, and other risk factors associated with diabetes. Compared with diabetic patients receiving medication, patients on diet management were more likely to have raised blood pressure and less likely to be on medication to reduce hypetension; they were 45% more likely to have raised cholesterol and less likely to be prescribed lipid-lowering medication. Although fewer of those treated by diet (68%) had diabetes-related complications compared with those on medication (80%), the rate was much higher than for the general population.

Dr Hippisley-Cox comments: “Our findings suggest that the management strategy of using diet only in type 2 diabetes is still very common and varies substantially between practices. This suggests inconsistency between clinicians in the decision to introduce hypoglycaemic medication. This result is consistent with other evidence showing variations between practices in clinical areas, and is especially important since more patients are cared for solely in general practice than are cared for solely in hospital. Patients with diabetes on diet only are receiving less intensive review of their condition, and fewer referrals to, for example, dieticians; they also have a high rate of complications. Although some individuals with type 2 diabetes might be effectively managed by diet only, there is a case for better routine surveillance; for more intensive therapy if glycaemic control, blood pressure, or cholesterol are not optimum, and if any diabetes-related complications occur; and for greater consistency of clinical practice concerning the decision to start medication. Almost 1% of the entire population have diabetes and are on diet only and therefore the study has substantial public health implications”