Factors associated with persistent poorly controlled diabetes mellitus: Clues to improving management in patients with resistant poor control
Open accessAbstract
OBJECTIVES: Patients with persistent poorly controlled diabetes mellitus (PPDM), defined as an uninterrupted hemoglobin A1c >8.0% for ≥1 year despite standard care, are at high risk for complications. Additional research to define patient factors associated with PPDM could suggest barriers to improvement in this group and inform the development of targeted strategies to address these patients' resistant diabetes. METHODS: We analyzed patients with type 2 diabetes from a multi-site randomized trial. We characterized patients with PPDM relative to other patients using detailed survey data and multivariable modeling. RESULTS: Of 963 patients, 118 (12%) had PPDM, 265 (28%) were intermittently poorly controlled, and 580 (60%) were well-controlled. Patients with PPDM had younger age, earlier diabetes diagnosis, insulin use, higher antihypertensive burden, higher low-density lipoprotein cholesterol, and lower statin use relative to well-controlled patients. Among patients with objective adherence data (Veterans Affairs patients), a larger oral diabetes medication refill gap was associated with PPDM. DISCUSSION: Strategies are needed to target-specific barriers to improvement among patients whose diabetes is resistant to standard diabetes care. Our data suggest that strategies for targeting PPDM should accommodate younger patients' lifestyles, include medication management for insulin titration and comorbid disease conditions, and address barriers to self-management adherence.
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The number of Americans with poorly controlled diabetes has been increasing, contributing to preventable morbidity and mortality.
“The number of Americans with poorly controlled diabetes has been increasing, contributing to preventable morbidity and mortality [10-12].”
From An Assessment of How Clinicians and Staff Members Use a Diabetes Artificial Intelligence Prediction Tool: Mixed Methods Study (2023) · cites this paper as [12]
The Introduction (page not available in our copy) says that type 2 diabetes prevalence is growing and that poor glycemic control increases the risk of complications, which supports the morbidity concern. It does not establish that the number of Americans with poorly controlled diabetes is increasing or specifically link poor control to mortality. (LLM, conf=0.85)
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Liaw, W. R., Ramos Silva, Y., Soltero, E. G., Krist, A., & Stotts, A. L. (2023) · JMIR AI · doi:10.2196/45032 · Cited by 14 · see citing works
“The number of Americans with poorly controlled diabetes has been increasing, contributing to preventable morbidity and mortality [10-12].”
Background
- Authors
- Crowley, M. J., Holleman, R., Klamerus, M. L., Bosworth, H. B., Edelman, D., & Heisler, M.
- Affiliations
- Durham VA Medical Center (US)
- VA Ann Arbor Healthcare System (US)
- Corresponding author
- Crowley, Matthew J
- ORCID
- Venue
- Chronic Illness
- Publisher
- SAGE Publications
- Published
- 2014-02-24
- Volume
- 10
- Issue
- 4
- Pages
- 291-302
- ISSN
- 1742-3953 (ISSN-L)
- 1745-9206
- PMC
- PMC4317345
- OpenAlex
- W2042702467
- Cited by
- 68
- References
- 2
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 10 · 2016: 5 · 2015: 2 · 2014: 1
- FWCI
- 4.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Chronic Illness (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r18dk076622-04)
- National Institute of Diabetes and Digestive and Kidney Diseases (5R18DK076622, R18 DK076622)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, glycemic control, HbA1c, diabetes self-management, medication adherence, insulin use, statin use, LDL cholesterol, diabetes complications
- MeSH terms
- Age Factors, Aged, Antihypertensive Agents, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Insulin, Male, Middle Aged, Patient Compliance, Risk Factors, Self Care, Sex Factors, Socioeconomic Factors, Disease Management, Racial Groups, Medication Adherence
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