Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study

Prim Care Diabetes. 2018 Feb;12(1):34-44. doi: 10.1016/j.pcd.2017.06.008. Epub 2017 Jul 18.

Abstract

Objective: Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain).

Materials and methodologies: A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records. Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest. 30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR=1.54 (1.50-1.58). The HbA1c control at ≤8% was 82.8% (82.2-83.3) and >9% was 7.6% (7.3-8.0), with OR 1.79 (1.69-1.89) and 2.62 (2.36-2.91) respectively. Control of BP and LDL-C show significant differences between the clusters.

Conclusions: An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C.

Keywords: Diabetes mellitus; Primary health care; Small-area analysis; Type 2; Variability in clinical practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anticholesteremic Agents / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Biomarkers / blood
  • Blood Glucose / drug effects*
  • Blood Glucose / metabolism
  • Blood Pressure / drug effects
  • Cholesterol, LDL / blood
  • Cluster Analysis
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Electronic Health Records
  • Female
  • Glycated Hemoglobin A / metabolism
  • Guideline Adherence / standards*
  • Guideline Adherence / trends
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / trends
  • Prevalence
  • Primary Health Care / standards*
  • Primary Health Care / trends
  • Retrospective Studies
  • Risk Reduction Behavior
  • Spain / epidemiology
  • Time Factors
  • Young Adult

Substances

  • Anticholesteremic Agents
  • Antihypertensive Agents
  • Biomarkers
  • Blood Glucose
  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human