Good glycaemic control: an international perspective on bridging the gap between theory and practice in type 2 diabetes

Background: Good glycaemic control is crucial in reducing the risk of diabetes-related complications. Despite the availability of evidence-based treatment guidelines, glycaemic control appears to remain suboptimal in most countries. Objectives: In this commentary we outline the extent to which diabetes guideline targets on HbA(1c) are being met in clinical practice and - where targets are being missed - to identify potential reasons for this shortfall. Furthermore, we discuss possible actions that may improve glycaemic control. Methods: A literature search of MEDLINE using 20 core terms was conducted to help assess the state of glycaemic control in patients with type 2 diabetes worldwide. Results: Despite clinical guidelines, evidence suggests that glycaemic control is suboptimal in most parts of the world, with average HbA(1c) values varying from 7.0% to 12.6% and thus above virtually all HbA(1c) recommendations. The potential reasons for this shortfall are numerous. However, lack of diabetes education and awareness of HbA(1c) appear to be particularly important. A number of education initiatives from around the world have been shown to improve HbA(1c) levels significantly and thus improve standards of care. Conclusions: Poor glycaemic control in patients with type 2 diabetes appears to be a worldwide problem. As the global rise in diabetes (and its complications) seems destined to affect many less affluent countries, it is essential that appropriate steps are taken to address the barriers to good glycaemic control and ultimately improve outcomes for all people with type 2 diabetes.