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Is Diet-Controlled Diabetes Really Controlled?

Physicians should monitor such patients carefully to avoid excess diabetes-related complications.

Tight control of type 2 diabetes reduces microvascular complications. Although many patients' diabetes is managed by diet alone without hypoglycemic medications, little information is available about the quality of care and clinical outcomes of such "diet-controlled" diabetic patients.

Researchers in the U.K. reviewed centralized electronic medical records of 253,618 patients from 42 ambulatory medical practices. Of 7870 patients with type 2 diabetes, 2463 (31.3%) were managed without medication (interpractice variation, 16%-73%). Compared with patients who were managed with hypoglycemic medications, patients who were treated without medication were more than twice as likely to have hemoglobin A_1c levels higher than 7.4%; were much less likely to have documentation of HbA_1c levels, blood pressure, cholesterol levels, or smoking status; were less likely to have microalbuminuria testing or screening for foot pulses; were more likely to have elevated blood pressure (and less likely to be on antihypertensive medication); and were more likely to have high cholesterol levels (and less likely to be on lipid-lowering medication). Both groups had high rates of diabetes-related complications (68% of patients managed without, and 80% managed with, medication).

Comment: Some patients with type 2 diabetes are able to achieve good glycemic control with diet and exercise alone. However, for many patients, the term "diet-controlled" suggests more optimism than science. Physicians should heed this study's findings and confirm that, in patients whom they are treating without medication, diabetes truly is well controlled, and they should monitor such patients adequately.

— Bruce Soloway, MD

Published in Journal Watch General Medicine August 17, 2004

Citation(s):

Hippisley-Cox J and Pringle M. Prevalence, care, and outcomes for patients with diet-controlled diabetes in general practice: Cross sectional survey. Lancet 2004 Jul 31; 364:423-8.

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