Handling of Patients with “Poorly Controlled” Diabetes Type 2
Eine Beobachtungsstudie von Hausärztengerman translation / full article
An Observational Study by Family Practitioners
Background: Therapy of diabetes is easy and defined in guidelines. Nevertheless many patients are “poorly controlled”.
Methods: 19 family doctors analysed all their “ poorly controlled” (HbA1c 9%) patients with diabetes in the beginning of 2013 using a prefixed questionnaire. They documented retrospectively their treatments, results of their interventions and the possible reasons for improvement or non-improvement until the beginning of 2015.
Results: We identified 168 patients who were distributed differently between the practices. A third of the practices had 8–15 % “poorly controlled” among all patients with diabetes; only two practices had less than 2 %. After two years, 43 % of initially 100 % still were „poorly controlled“; with some practices having more, others less. Nearly all practices employed only metformin, sulfonylureas and insulin. In 10 practices up to 20 % of the patients had their treatment changed during the two years. In a fourth of the patients a repeated “patient education” (several group sessions) took place and in a third longer consultations concerning the “control” were arranged. Reasons often given for not doing more were: “patient was not willing“, “this makes no sense“. Explanations for staying in “bad control” were: “patient has more important problems, different preferences“, “patient does not understand me“, “it is the diabetes, which makes the problem“.
Conclusions: We should maintain the orientation to do the best, which will result in some relevant success. Still, we have to accept that a number of patients have different goals, more important for them.