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

Abstract

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 C 1 year who had C 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.

Antidiabetic and Other Therapies Used in Subjects with Diabetes and Chronic Kidney Disease in a Hospital-Based Clinic Population in Greece

“…(b) In a retrospective cross-sectional study, HbA1c <7% was achieved by 42% of the patients [ 29 ]. (c) In a cross-sectional study conducted in 15 hospital-based outpatient clinics and 38 private practices located across Greece, HbA1c target was achieved by 82.1% of the subjects [ 30 ]. (d) A cross-sectional disease registry of current T2DM management, representing the majority of Diabetes Centers or Diabetes Outpatients Clinics, showed that the mean (±SD) HbA1c of the total population was 7.1 ±1.2% [ 31 ].…”

“…According to a survey conducted in the United States, 35% of patients with hypertension had their BP under control [ 62 ]. In the routine care setting in Greece, BP target was achieved by 42.6% of subjects with T2DM [ 30 ]. In our study, blockade of the rennin-angiotensin-aldosterone system with either an angiotensin-converting enzyme inhibitor (ACE-1) or an angiotensin II receptor blocker (ARB) were the most frequent antihypertensive agents in all stages of CKD.…”

“…Combination therapy for LDL-C lowering with statins and ezetimibe was 11.4% and 10.2%, respectively. In the routine care setting in Greece, LDL-C targets were achieved in 57.0% of the patients [ 30 ]. Randomized controlled trials have indicated that statins may preserve renal function.…”

Patient and Physician Associated Factors of Adherence to Evidence-Based Guidelines in Diabetes Mellitus Type 2

“…[16] However, those individuals with prediabetes who successfully lose weight, maintain a physical activity program and improve their lifestyle can be expected to benefit from decreased conversion to Diabetes. [17]…”

“…Most of the general practitioners reported that some patients were refused to change or improve their lifestyles through weight loss or maintain physical activity. [17] In 2020, there are many causes for the fact that the treatment of patients is not usually consistent with evidence-based guidelines. The most crucial factor of the physician's non-adherence are not providing adequate treatment.…”