Changes in Glycaemic Control in Community-based Australian Patients with Type 2 Diabetes Over Nearly Two Decades: The Fremantle Diabetes Study — ASN Events
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Changes in Glycaemic Control in Community-based Australian Patients with Type 2 Diabetes Over Nearly Two Decades: The Fremantle Diabetes Study (#85)

Timothy ME Davis 1 2 3 , K Peters 1 2 , B A Sillars 1 3 , S AP Chubb 1 , D G Bruce 1 2 3 , W A Davis 1 2 3
  1. University of Western Australia, Fremantle, WA, Australia
  2. School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, W.A., Australia
  3. Biochemistry Department, Fremantle Hospital, Fremantle, W.A., Australia

Background: There is some evidence from countries such as the US that glycaemic control is improving, reflecting better management. There are no equivalent Australian data.

Aim: To compare glycaemic indices and management in type 2 diabetic patients recruited to the community-based Fremantle Diabetes Study (FDS) Phase 1 between April 1993 and July 1996 with those of type 2 patients entering Phase 2 between February 2008 and June 2011.

Patients and Methods: We studied 1,296 Phase 1 patients from a postcode-defined area of 120,000 and 1,509 Phase 2 recruits from the same catchment area that had increased to a population of 150,000. HbA1c assays were performed in the same accredited laboratory and the values standardised to those generated using the assay in current use.

Results: Phase 2 patients were older (mean±SD 65.4±11.7 vs 64.0±11.3 years, P<0.001) and had longer diabetes duration (median [inter-quartile range] 8.0 [2.7-15.4] vs 4.0 [1.0-9.0] years, P<0.001), but similar proportions were male (48.6 vs 51.8%, P=0.10). Phase 2 patients had a greater body mass index (31.3±6.1 vs 29.6±5.4 kg/m2, P<0.001). More Phase 2 patients were taking insulin±oral agents (22.0% vs 12.3%), and fewer were managed with diet/exercise (24.6% vs 31.9%) or oral agents alone (53.4 vs 55.7%; P<0.001 by Fisher’s exact test). Glycaemic control was significantly better in the Phase 2 cohort (HbA1c 6.8 [6.2-7.7] vs 7.2 [6.2-8.5]% and fasting serum glucose 7.2 [6.2-8.9] vs 8.0 [6.5-10.3] mmol/L, P<0.001 in each case).

Conclusions: Despite longer diabetes duration and increased obesity, glycaemic control has improved during the 18 years spanned by the FDS in urban Australian type 2 patients. This may reflect changes in i) screening for diabetes in primary care, ii) diagnostic criteria, and/or iii) demographic features, but more intensive blood glucose lowering therapy also appears to play an important role.