Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg

• Published in: PloS one 2013-11, Vol.8 (11), p.e80162-e80162
• Main Authors: Renard, Laurence M, Bocquet, Valery, Vidal-Trecan, Gwenaelle, Lair, Marie-Lise, Blum-Boisgard, Claudine
• Format: Article
• Language: English
• Subjects: Adhesion; Aged; Analysis; Antidiabetics; Cohort analysis; Complications; Consultation; Criteria; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - psychology; Diabetics; Disease control; Disease management; EKG; Electrocardiography; Epidemiology; Female; Follow-Up Studies; Glucose; Glycated Hemoglobin A - metabolism; Glycosylated hemoglobin; Guideline Adherence - statistics & numerical data; Guidelines; Health insurance; Hemoglobin; Humans; Hyperglycemia; Hypoglycemic agents; Hypoglycemic Agents - therapeutic use; Kidney Function Tests; Lipoproteins - blood; Luxembourg; Male; Medical personnel; Medical research; Medicine; Metabolism; Middle Aged; Patient compliance; Patient Compliance - psychology; Patient Compliance - statistics & numerical data; Patients; Physicians; Population; Population studies; Practice guidelines (Medicine); Practice Guidelines as Topic; Proportional Hazards Models; Public health; Retina; Studies; Type 2 diabetes
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0080162

Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians' and patients' adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients' characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented. The exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068). Seven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model. In 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (-8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (OR(male): 0.87 [95%CI, 0.83-0.92]), the nationality (OR(NonEU): 0.64 [0.52-0.78]), the type of antidiabetic treatment (ORoral: 1.48 [1.35-1.63], OR(mixed): 1.35 [1.20-1.52]) and the type of treating physician (ORG-ID: 0.47 [0.42-0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria). A large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients.