Blood glucose control and quality of health care in non-insulin-treated patients with Type 2 diabetes in Spain: a retrospective and cross-sectional observational study

Abstract

Aims: To assess blood glucose control and quality of health care provided to non-insulin-treated patients with Type 2 diabetes mellitus in routine clinical practice in Spain.

Methods: In this observational, retrospective, cross-sectional study, patients were grouped as either having good or suboptimal blood glucose control according to International Diabetes Federation or American Diabetes Association HbA(1c) goals. Clinical and socio-demographic data and compliance with the main standard level of care recommendations of the International Diabetes Federation were recorded during a routine visit. Correlates of glucose control were analysed by logistic regression.

Results: Many patients were grouped as having suboptimal control under International Diabetes Federation (61.9%) or American Diabetes Association (45.0%) criteria. The mean number of accomplished International Diabetes Federation recommendations (7.3 out of 11) was higher for endocrinologists (than for internists or primary care physicians), and significantly more patients under their care were in the good glucose control group (than with primary care physicians). More recommendations were associated with blood glucose control using International Diabetes Federation than American Diabetes Association criteria, demanding higher quality of health care for achieving stricter goals. Some recommendations were poorly observed, particularly those concerning patients' education on diabetes, the prompt prescription of effective treatments and monitoring of complications. Diabetes complications were associated with being in the suboptimal control group. Patients' education on diabetes and HbA(1c) monitoring were associated with being in the good control group.

Conclusions: These results demonstrate the need for improvement in the management of patients with non-insulin-treated Type 2 diabetes in actual clinical practice in Spain. Such improvement would entail a stricter adherence to International Diabetes Federation recommendations.

FIGURE 1

International Diabetes Federation's recommendations for standard care assessed in this study. *Diabetes education refers to participation in non-evaluated, structured training sessions about diabetes course and complications, the therapeutic options available and self-care strategies that improve general therapeutic effectiveness. These sessions were conducted by a specialized nurse and, less frequently, by a specialised physician. Because there was not a protocol for these sessions, their contents varied from one site to another.

FIGURE 2

Patient disposition. ADA, American Diabetes Association; IDF, International Diabetes Federation.

FIGURE 3

Compliance with IDF recommendations according to glycaemic control per the IDF criteria and to the treating physician's specialty. BP, blood pressure; CV, cardiovascular; IDF, International Diabetes Federation; OHA, oral hypoglycaemic agent.