The Relationship Between Physicians’ Self-Reported Target Fasting Blood Glucose Levels and Metabolic Control in Type 2 Diabetes

Abstract

RESEARCH DESIGN AND METHODS -Physicians' beliefs were investigated through a questionnaire sent to a sample of self-selected clinicians participating in a nationwide initiative aimed at assessing the relationship between the quality of care delivered to patients with type 2 diabetes and their outcomes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (Ͻ65 vs. Ն65 years). Mean HbA 1c levels in the study population were thus evaluated according to target fasting blood glucose (FBG) used by their physicians.RESULTS -Of 456 physicians, 342 (75%) returned the questionnaire. Among the responders, 200 diabetologists and 99 general practitioners (GPs) recruited 3,297 patients; 2,003 of whom were always followed by the same physician and 1,294 of whom were seen by different physicians in the same structure on different occasions. Only 14% of the respondents used target FBG levels Յ6.1 mmol/l, whereas 38% pursued values Ͼ7.8 mmol/l, with no statistically significant difference between diabetologists and GPs. The analysis of the relationship between FBG targets and metabolic control, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA 1c values of 7.0 Ϯ 1.6 for patients in the charge of physicians pursuing FBG levels Յ6.1 mmol/l and 7.8 Ϯ 1.8 for those followed by physicians who used target values Ͼ7.8 mmol/l. After adjusting for patients' and physicians' characteristics, the risk of having HbA 1c values Ͼ7.0% was highly correlated with physicians' beliefs. Patients followed by different physicians in the same unit showed a risk of inadequate metabolic control similar to that of patients followed by physicians adopting a nonaggressive policy.CONCLUSIONS -Doctors adopt extremely heterogeneous target FBG levels in patients with type 2 diabetes, which in turn represent an important independent predictor of metabolic control. To improve patient outcomes, physicians-centered educational activities aimed at increasing the awareness of the potential benefits of a tight metabolic control in patients with type 2 diabetes are urgently needed. Diabetes Care 24:423-429, 2001T he recent results of the U.K. Prospective Diabetes Study (UKPDS) have confirmed, for type 2 diabetes, that intensive blood-glucose control substantially decreases the risk of developing complications of diabetes (1).However, how this information translates into a balance among the need for improving metabolic control, the fear of unwanted hypoglycemic effects, and the burden imposed by more intense treatment is not clear. We studied this translation in the context of the QuED Project, a nationwide initiative aimed at assessing the relationship between the quality of

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