The relationship between the level of knowledge of physicians on guidelines and the degree of glucometabolic control in type 2 DM patients in Turkey
I Satman1, S Imamoglu2, C Yilmaz1 & on behalf of ADMIRE Study Group3
Introduction: Clinical practice guidelines on diabetes mellitus (DM) was created by The Society of Endocrinology & Metabolism, Turkey (SEMT). The ADMIRE Project is designed to evaluate the effect of implementation activities to increase physicians awareness on guidelines.
Methods: A total of 180 physicians from national representative diabetes clinics kept medical records of 885 T2DM patients for 6 months, without any interference to their routine practice. Then, following awareness activities they kept medical records of 1616 T2DM patients for 6 months. Adherence to guidelines was scored to reach a total adherence to follow-up procedures (TOTAL_ADH_FU) for medical history (HISTORY), physical examination (PHY_EXAM) and laboratory evaluation (LAB_EVAL). Here, baseline results from pre-activity and post-activity periods (PRE and POST) are compared.
Results: PRE and POST data were similar (age 55 vs 57 years, women 62 vs 59% and DM duration 7.1 vs 7.4 years). Treatment preference in PRE and POST were OAD: 46 vs 55%, insulin: 11% in both, OAD+insulin: 25 vs 26%. In PRE, guidelines had been adhered fully for HISTORY in 41% of patients and increased to 85% in POST. The proportions of patients who had PHY_EXAM in full adherence were 9 vs 34% (P<0.001). Patients with LAB_EVAL in full adherence were 30 vs 22% (P<0.001). Only 22.9% of patients were at A1C target (≤6.5%) in PRE, while this figure increased to 28.3% at POST (P=0.014). Proportion of patients at FBG (70120 mg/dl) and PPBG targets (<140 mg/dl) changed from 17.5 and 12.620.7 and 12.8% in POST respectively. Mean A1C levels (%) in PRE and POST were 8.7±2.1 vs 8.4±2.1 (P=0.002). FBG (mg/dl) and PPBG levels (mg/dl) were 191±88 vs 178±77 (P=0.001) and 248±106 vs 240±99 respectively.
Conclusion: Awareness activities significantly increased the proportion of patients at A1C target and decreased both the level of A1C and FBG.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.