Abstract
In order to determine the level of glycaemic control attainable and the related benefit of intensive insulin therapy in routine clinical diabetes practice, a cross‐sectional survey of an adult diabetes clinic population was undertaken. We audited 2,066 adult patients with diabetes: age 5±15yr (mean±SD); 1,207 (58%) male; 72% Caucasians; 1,261 (61%) on insulin. Mean HbA~1c~ was 6.7±1.7% (normal <5.5%) with no significant effects of age, sex, racial origin, micro‐ and/or macrovascular complications, but treatment category was significant: HbA~1c~ on diet 6.4±1.6%, on tablets 6.6±1.6% and on insulin 6.8±1.7% (p<0.01). Amongst insulin‐treated patients (age 54±16yr; 56% male; 76% Caucasian), 1,072 (85%) were on conventional insulin regimens and 189 (15%) on intensive insulin regimens. No significant effects were found for age, sex, race, complications or insulin regimen (HbA~1c~ conventional 6.7±1.7% vs intensive 6.9±1.7%) despite the intensive group being younger (56±16yr vs 39±13y, p<0.001). In patients aged <40yr and treated with insulin within one year of diagnosis (n=293, age 31±6yr, 54% male, 83% Caucasians, 105 (36%) on intensive regimens) HbA~1c~ was 6.8±1.7% in conventional vs 7.0±1.7% in intensively treated patients (ns).
We conclude that, in routine practice, conventional and intensive insulin regimens achieve equivalent glycaemic control and are both favourably comparable to the intensively managed group of the DCCT.