Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study

Abstract

Introduction: Physician adherence, or lack therefore, to diabetes care and follow-up guidelines may be linked to the rates of achieving suboptimal glycaemic, blood pressure and lipid targets in people with type 2 diabetes mellitus (T2DM). In this cross-sectional study we evaluated physician adherence to the patient follow-up protocol (PFP) of the 2017 Hellenic Diabetes Association (HDA) guidelines and also assessed glycated haemoglobin (HbA_1c), blood pressure and lipid control achievement rates in the routine care setting in Greece.

Methods: Eligible subjects were adults with T2DM receiving oral hypoglycaemic agents (OHAs) for ≥ 1 year who had ≥ 2 HbA_1c measurements in the previous year and an HbA_1c target < 7%. Overall adherence at the subject level was defined as the percentage of the 62 HDA PFP items that had been met during the past year.

Results: Between June and December 2018, 601 eligible subjects (54.6% men; mean age 65.2 years; median T2DM duration 5.9 years, of whom 96.5% had ≥ 1 medical condition/comorbidity), were enrolled into the study by 53 hospital- and office-based endocrinologists, internists and general practitioners. The main OHAs prescribed at enrolment were metformin (91.0%), dipeptidyl peptidase-4 inhibitors (60.7%), sodium-glucose co-transporter-2 inhibitors (23.5%) and sulphonylureas (16.3%). Mean overall physician adherence to the PFP was 43.6%. Predictors of greater higher physicans' adherence were female sex (p = 0.026), > 3 medical conditions/comorbidities (p = 0.043) and diabetic complications (p < 0.001). HbA_1c, low-density lipoprotein-cholesterol, systolic/diastolic blood pressure and composite metabolic targets were achieved by 82.1, 57.0, 42.6 and 21.6% of subjects, respectively.

Conclusions: In Greek routine care, physician adherence to the PFP of the 2017 HDA guidelines is suboptimal. Future efforts should focus on identifying the barriers to an adequate adherence by physicians to the full PFP, with the aim to provide optimal patient care.

Keywords: Follow-up; Glycated haemoglobin A1c; Guideline adherence; Target attainment; Type 2 diabetes mellitus.

Fig. 1

Subject disposition and flow chart. Flow chart displaying the number of subjects enrolled and analysed, and the number of enrolled subjects analysed per physician specialty and healthcare setting

Fig. 2

Diabetes guidelines followed by physicians overall and according to physicians’ specialty. Bars and labels indicate percentage of subjects for which each guideline was followed. More than one guideline was followed for some participants. AACE/ACE American Association of Clinical Endocrinologists/American College of Endocrinology, ADA/EASD American Diabetes Association/European Association for the Study of Diabetes, HDA Hellenic Diabetes Association

Fig. 3

Adherence to the patient follow-up protocol (PFP) of the HDA guidelines overall and according to physicians’ specialty. Bars represent the mean and standard deviation, while the labels indicate means

Fig. 4

Achievement of glycaemic control and action taken with current antidiabetic medication by physicians at enrolment. a Glycaemic control achievement rate, overall and according to physicians’ specialty. Labels indicate the percentages of participants achieving control, and N is the number of patients for whom data were available on haemoglobin A_1c (HbA_1c). b Glycaemic control achievement rate by number of antidiabetic treatment classes received. Labels indicate the percentages of participants achieving control, and N is the number of patients for whom data were available on HbA_1c. c Distribution of participants [in absolute numbers (N)] attaining the target HbA_1c < 7% according to the action to be taken with their antidiabetic medication at enrolment. d Distribution of participants [in absolute numbers (N)] failing to attain the target HbA_1c < 7% according to the action to be taken with their antidiabetic medication at enrolment