Inequalities in glycaemic control in patients with Type 2 diabetes in primary care

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Abstract
Aims To quantify relationships between patient and practice factors and glycaemic control in patients with Type 2 diabetes. Methods A cross‐sectional study involving 1534 patients with Type 2 diabetes from 42 general practices in Nottingham, UK was undertaken. Patient characteristics were assessed by a clinical interview and case note review and practice characteristics by a questionnaire. The outcome measure was serum HbA1c concentration measured at entry to the study. Random effects linear regression was used to model patient and practice factors associated with glycaemic control. Results In multivariable regression analysis, HbA1c increased with increasing body mass index (BMI) [change in HbA1c for one unit increase in BMI: 0.03%, 95% confidence interval (CI) 0.01, 0.04], and was higher in those using oral medication (mean difference 0.75%, 95% CI 0.59, 0.92) or insulin compared with diet (mean difference 1.36%, 95% CI 1.10, 1.62). There was a dose–response relationship between HbA1c and increasing time since diagnosis. HbA1c was negatively associated with age (change per year −0.01%, 95% CI −0.02, −0.004). Patients registered at the most deprived practices had higher HbA1c values than those in the least deprived practices (mean difference 0.42%, 95% CI 0.14, 0.71), as did those in practices where annual reviews were carried out by the nurse alone (mean difference 0.24%, 95% CI 0.04, 0.44). Conclusions Several patient and practice factors are related to glycaemic control. Poorer glycaemic control was associated with practice level deprivation and nurses undertaking annual reviews alone. Further research is required to explore outcomes of annual reviews undertaken by nurses alone. Greater resources may be needed by primary care teams working in deprived areas to address inequalities in diabetic control.