Legal and clinical meaning of "poorly controlled"

Apologies first of all as this is a sort of cross post of another thread that ended up going off topic into people's perceptions - an interesting subject but not what I was looking to find out.

I'm trying to find out what the clinical meaning of "poorly controlled" diabetes is, whether or not it necessarily involves blame of the patient for their conduct (e.g. does it imply that the health problem is avoidable or reduceable by the patient). And from there, where does the "poorly controlled" diabetic stand in relation to litigation, in employment for example. Can they be held not to have taken 'reasonable measures' to cope with their condition, and thus fall outside Equality Act protection?

Here are some clinical links

http://en.wikipedia.org/wiki/Diabetes_management#Glycemic_control (definition in last paragraph)

this study (for T2) gives an HBa1c based definition and says that those that are poorly controlled have "resistant diabetes"
http://www.ncbi.nlm.nih.gov/pubmed/24567193

this study (also T2) http://www.cardiab.com/content/11/1/70
also gives an HBa1c based definition, says that no predictors could be found to design interventions to improve control, and that the majority of "poorly controlled" diabetics were rated as having "very good or good" compliance with their care plan.

There's also a study from Jordan that does correlate poor control with poor compliance - particular with the recommended diet and exercise regime for T2s - only 15 of the poorly controlled T2s were eating their Eat Well Plate or whatever the Jordanian equivalent is. However this quick literature check suggests that the clinical meaning is just that BG and HBa1c are outside of target, and that (at least some of) the evidence shows that this is independent of the patients' compliance and behaviour.

Any views on that being the clinical definition? And what about the legal implications? Let's assuming we're talking about medicated diabetics, not diet-only.

justbe said:

I mostly think of this term as victim blaming. No one working with diabetics should be allowed to use it, at least.

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Sympathise, but, it's an official term with a defined meaning that is used by HCPs to determine treatment approaches for diabetics. Such as whether they are eligible for a pump, for example.

For the NHS "poorly controlled" just means outside of (NHS) targets. It is not *intended* to imply anything about the patient's efforts or capabilities. Nor does it specifically imply brittle diabetes etc. It could be one or the other or a combination, or some other explanation.

It simply describes an outcome, not the cause of that outcome.

Well I posted this in April with no replies.

Since that time I got some answers offline.

ElyDave said:

Poorly controlled to me implies not meeting desired parameters (outputs) measured as average BG, HbA1c etc

Although there may be an inference in the uneducated as to cause, I don't think clinically that is implied as poor control could be a result of either clinical features of an individual's diabetes or the choices they make in their self-management

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Yes. After talking to my senior consultant about this, I get the impression the clinicians' meaning of the term, more subtly, is that patient non-compliance etc is "not *necessarily* implied".

AndBreathe said:

I would say the big issue here is where the writer and reader make differing interpretations of the same words; especially in the light of no official definition no could counter any argument with. Or have you managed to sort that definition out, Spiker?

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I agree and no I don't have a written statement of the medical understanding of the term that could be used in a tribunal etc. I just had a chat with my own consultant.

dannyw said:

Good question. Perhaps there should be another label, "poorly managed" ? This could possibly differentiate between those trying hard but still achieving results outside NHS guidelines and those who know how to control their diabetes but can't be bothered or refuse to follow advice ?

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Two more labels (at least) are needed:

"bloody know all" - people who refuse to follow NHS advice and achieve better results than the NHS targets

"poor sods" - people who do exactly as they are told by the NHS, still don't achieve the targets, and get accused of lying.

:-/