Methodology and early findings of the Diabetes Management Project: a cohort study investigating the barriers to optimal diabetes care in diabetic patients with and without diabetic retinopathy

Background: The Diabetes Management Project is investigating the clinical, behavioural and psychosocial barriers to optimal diabetes care in individuals with and without diabetic retinopathy. Design: Prospective cohort. Participants: Two hundred and twenty-three and 374 patients without and with diabetic retinopathy, respectively. Methods: All individuals underwent a comprehensive dilated eye test, anthropometric measurements, blood and urine samples, and psychosocial questionnaires. Main Outcome Measures: Good glycaemic control was defined as glycosylated haemoglobin <7%, good blood pressure control as systolic and diastolic values <= 130 and 80 mmHg, respectively, and good diabetes control as glycosylated haemoglobin <7% and blood pressure values <= 130 and 80 mmHg. Results: Four hundred and one males (65.4%) and 212 females (34.6%) aged 26-90 years (mean age +/- standard deviation = 64.6 +/- 11.6) were examined. The median glycosylated haemoglobin for all participants was 7.5% (interquartile range = 1.7%). Average systolic and diastolic blood pressure values were 139.7 mmHg (standard deviation = 18.8) and 92.7 mmHg (standard deviation = 30.9), respectively. Initial data analyses indicate that over two-thirds of participants with diabetes have poor glycaemic control, which was worse in those with diabetic retinopathy compared with those without (76.3% vs. 49.3%; P < 0.001). Blood pressure control was similar for those with and without diabetic retinopathy, with almost a third (28.5%) of the total sample having poor blood pressure control. Overall, those with diabetic retinopathy had poorer diabetes control than those without (24.3% vs. 13.7%; P = 0.002). Conclusions: Our findings substantiate the implementation of the Diabetes Management Project, developed to assess factors associated with suboptimal diabetes care.