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

• Published in: Diabetes therapy Vol. 11; no. 12; pp. 2887 - 2908
• Main Authors: Papanas, Nikolaos, Elisaf, Moses, Kotsa, Kalliopi, Melidonis, Andreas, Bousboulas, Stavros, Bargiota, Alexandra, Pagkalos, Emmanouel, Doupis, John, Ioannidis, Ioannis, Avramidis, Iakovos, Pappas, Angelos C., Karousos, Gerasimos, Arvaniti, Eleni, Bristianou, Magdalini, Pietri, Katerina, Karamousouli, Eugenia, Voss, Bernd, Migdalis, Ilias, Tentolouris, Nikolaos
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-12-2020; Springer; Springer Nature B.V
• Subjects: Antidiabetics; Best practice; Blood pressure; Cardiology; Care and treatment; Continuity of care; Continuum of care; Diabetes; Diabetes therapy; Drug therapy; Endocrinology; Family physicians; Hypoglycemia; Internal Medicine; Management; Medicine; Medicine & Public Health; Original Research; Physicians; Practice; Type 2 diabetes; Greece; Guideline adherence; Target attainment; Type 2 diabetes mellitus; Glycated haemoglobin A1c; Follow-up
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-020-00935-6

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.