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Review
. 2017 May;14(3):172-183.
doi: 10.1177/1479164116679775. Epub 2017 Feb 1.

Gaps and barriers in the control of blood glucose in people with type 2 diabetes

Lawrence Blonde  1 , Pablo Aschner  2 , Clifford Bailey  3 , Linong Ji  4 , Lawrence A Leiter  5 , Stephan Matthaei  6 ; Global Partnership for Effective Diabetes Management
Affiliations
Review

Gaps and barriers in the control of blood glucose in people with type 2 diabetes

Lawrence Blonde et al. Diab Vasc Dis Res. 2017 May.

Abstract

Background: Glycaemic control is suboptimal in a large proportion of people with type 2 diabetes who are consequently at an increased and avoidable risk of potentially severe complications. We sought to explore attitudes and practices among healthcare professionals that may contribute to suboptimal glycaemic control through a review of recent relevant publications in the scientific literature.

Methods: An electronic search of the PubMed database was performed to identify relevant publications from January 2011 to July 2015. The electronic search was complemented by a manual search of abstracts from key diabetes conferences in 2014/2015 available online.

Results: Recently published data indicate that glycaemic control is suboptimal in a substantial proportion (typically 40%-60%) of people with diabetes. This is the case across geographic regions and in both low- and higher-income countries. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type 2 diabetes. In particular, prescribers are often willing to tolerate extended periods of 'mild' hyperglycaemia as well as having low expectations for their patients. There are often delays of 3 years or longer in initiating or intensifying glucose-lowering therapy when needed.

Conclusion: Many people with type 2 diabetes are failed by current management, with approximately half not achieving or maintaining appropriate target blood glucose levels, leaving these patients at increased and avoidable risk of serious complications. Review criteria: The methodology of this review article is detailed in the 'Methods' section.

Keywords: Diabetes mellitus; clinical inertia; glycaemic control; review; surveys; type 2.

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Conflict of interest statement

Declaration of conflicting interests: Larry Blonde has received research support from Eli Lilly and Company, Novo Nordisk and Sanofi and has received speaker/consultant honoraria from Amylin Pharmaceuticals, Johnson & Johnson – Janssen, Johnson & Johnson Diabetes Institute, Merck & Co., Inc., Pfizer Inc, Novo Nordisk, Sanofi and Santarus. Dr Blonde’s late spouse’s estate contains shares of Pfizer. Pablo Aschner is a member of the Global Partnership for Effective Diabetes Management and has received honoraria from GlaxoSmithKline for his participation in board meetings and other related scientific activities. He has also participated in advisory panels and provided ad hoc consultancy to AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Merck Sharp & Dohme, Novartis and Sanofi-Aventis. Clifford Bailey has received research support from AstraZeneca, Sanofi-Aventis and has received presentation support from, has participated in advisory panels and provided ad hoc consultancy to, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Merck, Novo Nordisk and Takeda. Linong Ji has received fees for lectures and consulting from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, Metabasis, Novartis, Eli Lilly, Roche, Sanofi-Aventis and Takeda. Lawrence Leiter has received research funding and has acted as a consultant to Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Novo Nordisk, Roche, Sanofi-Aventis, Servier and Takeda. Stephan Matthaei has received research support from Sanofi-Aventis and Novo Nordisk and honoraria for advisory boards and/or speaker engagements from AstraZeneca, Bayer, Bristol-Myers Squibb, Disetronic, Eli Lilly, GlaxoSmithKline, LifeScan, Merck, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi-Aventis and Takeda.

Figures

Figure 1.
Figure 1.
Proportion of healthcare professionals reporting that healthcare in their country is well organized for the management of chronic conditions, including debates. Source: Adapted from Holt et al.
Figure 2.
Figure 2.
Leading reasons for not initiating glucose-lowering therapy. Results from an online survey of 508 US primary care physicians providing clinical date for 770 patients. Source: Adapted from Marrett et al.
See this image and copyright information in PMC

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