Nationwide Survey on Actual Interventions for Type 2 Diabetes by Japanese Practitioners (NSAID Study-1): Glycemic, Weight, and Blood Pressure Management

Abstract

Introduction: Considering the increase in the number of patients with diabetes, the quality of diabetes care provided by general practitioners (GP) is critical for preventing complications. We performed a nationwide survey to determine whether the diabetic management provided to patients with type 2 diabetes mellitus (T2DM) by Japanese practitioners is appropriate. Methods: We randomly selected 463 clinics throughout Japan; 8070 patients with T2DM (6525 and 1545 under the care of GP and specialists [SP], respectively) were enrolled. We obtained information on hemoglobin A1c (HbA1c) levels, age, height, body weight, diabetes type and treatment modality, blood pressure (BP), and hypertension or dyslipidemia from each patient. Additionally, we surveyed the collaborations among physicians. Results: The median HbA1c level of patients treated by GP was lower than that of patients treated by SP (6.8 [6.2-7.3], median [interquartile range] vs. 6.9 [6.5-7.5], p \ 0.0001). The percentage of patients receiving insulin therapy was also higher (23.8%) among patients treated by SP than among those treated by GP (8.6%). Patients not receiving insulin therapy showed lower median HbA1c levels than those receiving insulin therapy, irrespective of the care provider. The mean body mass index of patients with HbA1c levels \ 6.9% or [ 9.0% cared for by SP was lower than that of those cared for by GP. The rate of target BP (\ 140/90 mmHg) achievement was 73.2% and 73.3% among patients with T2DM and hypertension cared for by GP and SP, respectively. Furthermore, 88.2% of GP reported that consulting with SP was easy.

Differences in Dental Care Referral for Diabetic Patients Between General Practitioners and Diabetes Specialists in Japan, Analyzed from NSAID-Study 3

“…We had already described that the limitations of this study include the sample size and nature of the participants, while we randomly selected approximately 15% of the JMDPIMC members for study eligibility, and 6.9% participated in this study. The ratio of specialists to general practitioners in this study was 16.8% [ 11 ]. Even though this ratio is close to the ratio of certified diabetologists to general practitioners in Japan, it may not even be representative of the whole GP and diabetes specialist world in Japan.…”

“…Even though this ratio is close to the ratio of certified diabetologists to general practitioners in Japan, it may not even be representative of the whole GP and diabetes specialist world in Japan. Furthermore, we did not collect precise information about the patients, such as duration of diabetes and complications, because the method of data collection was administration of a questionnaire among the busy practitioners as reported previously [ 11 ]. Questionnaires represent a simple yet easily biased method to investigate such a problem.…”

“…Therefore, physician who care for patients with diabetes and dentists or oral care providers need to understand the importance of their collaboration and refer patients with diabetes to each other. The aim of this study was to clarify whether the awareness of need to refer diabetic patients to dentists is different in general practitioners from that in diabetes specialists, using secondary analysis of data from the 2018 Nationwide Survey on Actual Intervention for T2DM by Japanese Practitioners (NSAID Study) [ 11 ].…”