Intended for healthcare professionals

Rapid response to:

General Practice

Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk

BMJ 1998; 317 doi: (Published 31 October 1998) Cite this as: BMJ 1998;317:1202

Rapid Response:

Does a difference in prescribing explain some of the findings?

EDITOR - Professor Anne Louise Kinmouth and her colleagues are to be
congratulated on completing such an excellent study. It has important
implications for general practice as the authors suggest that
practitioners who concentrate on being patient centred might be at risk
of losing the focus on disease management. One of the findings that
supports this conclusion is that patients in the intervention group
gained weight.

In the discussion, it was suggested that this difference between the
two groups could not be accounted for by small differences in prescribing
rates of hypoglycaemic agents (50% in the intervention group and 46% in
the comparison group). There were, however, larger differences between
the groups in the type of hypoglycaemic agent prescribed. In the
intervention group, 47% were prescribed a sulphonylurea and 11% a
biguanide. In the comparison group the figures were 40% and 15%
respectively. Given that sulphoylureas tend to cause weight gain and
biguanides promote weight loss, might not some of the difference in
weight be accounted for by this difference in prescribing?

Christopher Hand

Competing interests: No competing interests

02 November 1998
Christopher H Hand
Adviser Postgraduate General Practice Anglia & Oxford Region, Honorary Senior Lecturer UEA
School of Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ