Is Diet-Controlled Diabetes Really Controlled?

Tight control of type 2 diabetes reduces microvascular complications. Although many patients' diabetes is managed by diet alone without hypoglycemic medications, little information is available about the quality of care and clinical outcomes of such "diet-controlled" diabetic patients.

Researchers in the U.K. reviewed centralized electronic medical records of 253,618 patients from 42 ambulatory medical practices. Of 7870 patients with type 2 diabetes, 2463 (31.3%) were managed without medication (interpractice variation, 16%-73%). Compared with patients who were managed with hypoglycemic medications, patients who were treated without medication were more than twice as likely to have hemoglobin A_1c levels higher than 7.4%; were much less like…