Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 31:9:978345.
doi: 10.3389/fmed.2022.978345. eCollection 2022.

Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study

Tabassum Saher  1 , Yaser Mohammed Al-Worafi  2 , Muhammad Nouman Iqbal  3 , Abdul Wahid  1 , Qaiser Iqbal  4 , Asad Khan  1 , Muhammad Atif  5 , Nafees Ahmad  1
Affiliations

Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study

Tabassum Saher et al. Front Med (Lausanne). .

Abstract

Background: Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines.

Objective: To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control.

Methods: This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A p-value <0.05 was considered statistically significant.

Results: Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations (p-value <0.05) with guidelines' compliant prescriptions. The group of doctors comprised of specialists and consultants wrote significantly (p-value = 0.004) high number of guidelines adherent prescriptions (mean rank = 20.25) than the group comprised of medical officers (mean rank = 11.34). On visit 2, only 39.5% patients were on goal glycemic levels. In MVBLR analysis, suffering from dyslipidemia (OR = 0.134) and CKD (OR = 0.111), receiving sulfonylurea (OR = 0.156) and guidelines' compliant prescription (OR = 4.195) were significantly (p-value <0 .05) associated with glycemic control.

Conclusion: Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.

Keywords: chronic kidney diseases; diabetes mellitus; glycemic control; metformin; polytherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Association AD. Diagnosis and classification of diabetes mellitus. Diab Care. (2014) 37(Supplement 1):S81–90. 10.2337/dc14-S081 - DOI - PubMed
    1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: global, regional, and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diab Res Clin Pract. (2022) 183:109119. 10.1016/j.diabres.2021.109119 - DOI - PMC - PubMed
    1. Borgharkar SS, Das SS. Real-world evidence of glycemic control among patients with type 2 diabetes mellitus in India: the TIGHT study. BMJ Open Diab Res Care. (2019) 7:e000654. 10.1136/bmjdrc-2019-000654 - DOI - PMC - PubMed
    1. Lautsch D, Boggs R, Wang T, Gonzalez C, Milligan G, Rajpathak S, et al. Individualized HbA1c goals, and patient awareness and attainment of goals in type 2 diabetes mellitus: a real-world multinational survey. Adv Ther. (2022) 39:1016–32. 10.1007/s12325-021-01985-3 - DOI - PMC - PubMed
    1. Blonde L, Aschner P, Bailey C, Ji L, Leiter LA, Matthaei S, et al. Gaps and barriers in the control of blood glucose in people with type 2 diabetes. Diab Vasc Dis Res. (2017) 14:172–83. 10.1177/1479164116679775 - DOI - PMC - PubMed

LinkOut - more resources