The role of an intensive multidisciplinary intervention on glycaemic control and clinical indicators in type 2 diabetes mellitus

[Truncated abstract] It is estimated that 7% of Australian adults have overt type 2 diabetes mellitus (T2DM) (Shaw & Chisholm, 2003), and suggested that up to 50% of T2DM cases remain undiagnosed (Colagiuri, Colagiuri, Conway, Grainger, & Davey, 2003). With an aging population and detrimental trends in obesity, physical activity and dietary habits, the number of cases of T2DM is predicted to rise to 1.7 million by the year 2030 (World Health Organisation, 2009). Increased body weight has been shown to contribute to the risk of developing several chronic conditions including CVD, diabetes, osteoarthritis, some cancers, hypertension and hypercholesterolaemia (World Health Organisation). Being overweight has been shown to be the strongest predictor of developing T2DM (Chan, Rimm, Colditz, Stampfer and Willett, 1994). Every decrease in HbA1c of 1% equates to a decrease in microvascular complications of 37% and a decrease in risk of MI of 14%. Decreasing HbA1c also decreases the absolute risk of developing CHD by 5-17% and all cause mortality by 6-15% (Chudyk & Petrella, 2011). Individuals with T2DM are at greater risk of premature cardiac events than those without (Wingard, Barrett-Connor, & Ferrara, 1995). It is well established that the risk of developing complications increases dramatically with an increase in hyperglycaemia (Stratton et al., 2000). Average glucose and HbA1c have been shown to be strongly associated with CVD (Borg et al., 2010). Khaw et al. (2001) found that a 1% increase in HbA1c was associated with a 20 to 30% increase in mortality as a result of cardiovascular disease. Studies have shown that decreasing HbA1c by as little as 0.2% can reduce mortality by 10% (K. T. Khaw et al., 2004). Other research suggests that for every 1% decrease in HbA1c there is a 30-35% reduction in retinopathy, nephropathy and neuropathy (Ohkubo, 1995).