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Diabetes Research

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Patients with both diabetes and other chronic conditions can still achieve good glycemic control

Patients who suffer from adult-onset (type 2) diabetes often suffer from other chronic diseases as well, such as hypertension and heart disease, which can complicate their care. In a recent study, however, patients who received intensive therapy at a specialty diabetes clinic were able to achieve good blood sugar (glycemic) control despite their other chronic conditions. The study was supported in part by the Agency for Healthcare Research and Quality (HS09722) and conducted by researchers at Emory University School of Medicine in Atlanta.

Lead author Imad M. El-Kebbi, M.D., and his colleagues studied 654 consecutive patients with type 2 diabetes who were treated in a diabetes clinic in 1997 and 169 patients who had a followup visit at 6 months. The study patients were 90 percent black, and 66 percent female, with an average age of 53. The researchers assessed the impact of age, body mass index (a measure of obesity), diabetes duration, type of therapy, and Chronic Disease Score (CDS)—(a weighted score that represents the number and severity of chronic diseases)—on the patients' blood sugar (HbA1c) levels.

When patients first came to the clinic, their average HbA1c level was 8.8 percent, and their average CDS was 1,121 (range 232-7,954). To put this in perspective, a 40-year-old man with uncomplicated diabetes would have a CDS of 232, whereas a 40-year-old man with diabetes, hypertension, and cardiac and vascular disease would have a score of 3,018. Twenty percent of these patients were being treated with diet alone, 48 percent with oral medications, and 32 percent with insulin alone or in combination with oral medications. The most common other chronic illness was hypertension, which affected 55 percent of the patients.

Six months after treatment at the clinic, which included adding or changing oral medication or adding insulin to the treatment regimen to further reduce blood sugar levels, a group of 169 patients, who were clinically similar to the overall group, had improved their average HbA1c level from 8.8 percent at the initial visit to 7.5 percent. Only patient age and diabetes duration, not the chronic disease score, significantly contributed to posttreatment HbA1c levels.

More details are in "Comorbidity and glycemic control in patients with type 2 diabetes," by Dr. El-Kebbi, David C. Ziemer, M.D., Curtiss B. Cook, M.D., and others, in the May 2001 Archives of Internal Medicine 161, pp. 1295-1300.

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