Background: Clinical practice guidelines on diabetes mellitus (DM) have been developed in 2006 by The Society of Endocrinology and Metabolism of Turkish (SEMT). The ongoing ADMIRE Project is designed to evaluate the effect of implementation of various activities to increase the awareness of physicians on the adherence to SEMT guidelines. The first phase results of the project is presented.
Methods: Of 180 physicians evaluated previous 12 months medical records of their type 2 DM patients with special emphasis on whether the patients were followed consistently with SEMT guidelines. This report depends on the analysis of 6032 visits of 1790 patients.
Results: Of 62% of patients were women, mean duration of DM 7.7 years and mean age 58.7 years. Of 60% of the patients had any chronic and ¼ of any acute complication within previous year. Of 96% was under pharmacotherapy (61% OAD,15% insulin and 20% OAD + insulin). The rate of SMBG was 40% at first, and increased to 51% by the end. Overall 30% of the patients was not in full compliance with SEMT guidelines in any visit within the previous year (DM symptoms 6%, acute 12% and chronic complications 10%, CV risk factors 6% and family history of DM 15%). In only 8% of patients, physical examination was performed in full compliance with SEMT guidelines at least once (height 48%, weight 40%, waist 74%, BP 11%, thyroid 35%, neurologic 46%, feet 35% and eye 57%). In only 18% of patients, laboratory evaluation was performed in full compliance with SEMT guidelines at least once (lipid profile 6%, creatinine 15%, microalbuminuria 72% and ECG 21%). Only 16% of patients were at A1C target (≤6.5%) at first visit, this gradually increased to 23% (proportions at target at first FBG 14%, PPBG 10% and increased to 29 and 17% by the end of the year). Mean A1C decreased from 8.5% at first visit to 7.6%, FBG from 190 mg/dl to 153 mg/dl, and PPBG from 236 mg/dl to 195 mg/dl during the previous year. Proportion of patients with good glycemic control was lower in females (P=0.042), with longer duration of DM (P=0.38), and the number of chronic complications (P=0.002). Adherence to physical and laboratory recommendations was associated with good glycemic control.
Comment: The level of medical care offered to patients with DM in Turkey is not sufficient. Physicians should be specifically trained to increase the level of adherence to guidelines during their clinical practice.