Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study.
chronic kidney diseases
diabetes mellitus
glycemic control
metformin
polytherapy
Journal
Frontiers in medicine
ISSN: 2296-858X
Titre abrégé: Front Med (Lausanne)
Pays: Switzerland
ID NLM: 101648047
Informations de publication
Date de publication:
2022
2022
Historique:
received:
25
06
2022
accepted:
12
10
2022
entrez:
17
11
2022
pubmed:
18
11
2022
medline:
18
11
2022
Statut:
epublish
Résumé
Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines. To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control. This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations ( Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.
Sections du résumé
Background
UNASSIGNED
Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines.
Objective
UNASSIGNED
To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control.
Methods
UNASSIGNED
This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A
Results
UNASSIGNED
Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations (
Conclusion
UNASSIGNED
Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.
Identifiants
pubmed: 36388939
doi: 10.3389/fmed.2022.978345
pmc: PMC9661729
doi:
Types de publication
Journal Article
Langues
eng
Pagination
978345Informations de copyright
Copyright © 2022 Saher, Al-Worafi, Iqbal, Wahid, Iqbal, Khan, Atif and Ahmad.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
J Eval Clin Pract. 2013 Oct;19(5):798-804
pubmed: 22583820
BMJ Open Diabetes Res Care. 2020 Sep;8(1):
pubmed: 32873600
Worldviews Evid Based Nurs. 2019 Apr;16(2):142-150
pubmed: 30861333
BMC Fam Pract. 2014 Apr 23;15:72
pubmed: 24755412
Int J Hypertens. 2018 Mar 12;2018:8524063
pubmed: 29721335
J Med Assoc Thai. 2011 Feb;94 Suppl 1:S159-67
pubmed: 21721442
Diabetes. 2001 Feb;50(2):315-21
pubmed: 11272142
Diabetes Care. 2014 Jan;37 Suppl 1:S81-90
pubmed: 24357215
J Diabetes Res. 2020 Jan 28;2020:5901569
pubmed: 32090121
Curr Med Res Opin. 2014 Nov;30(11):2233-40
pubmed: 25105305
Clin Diabetes. 2019 Jan;37(1):11-34
pubmed: 30705493
PLoS One. 2012;7(4):e33839
pubmed: 22509263
Int J Qual Health Care. 1999 Jun;11(3):187-92
pubmed: 10435838
Int J Health Sci (Qassim). 2018 Jan-Feb;12(1):40-44
pubmed: 29623016
Diabetes Care. 2001 Jun;24(6):1079-86
pubmed: 11375374
Clin Ther. 2017 Apr;39(4):759-770
pubmed: 28342563
Drugs. 2004;64(12):1339-58
pubmed: 15200348
Diabetes Ther. 2021 Jul;12(7):1887-1899
pubmed: 34050897
BMJ Open Diabetes Res Care. 2020 Jul;8(1):
pubmed: 32675172
Singapore Med J. 2005 Mar;46(3):127-31
pubmed: 15735877
PLoS One. 2021 May 11;16(5):e0251506
pubmed: 33974654
BMC Health Serv Res. 2013 Oct 25;13:442
pubmed: 24160916
Nat Rev Cardiol. 2013 Feb;10(2):73-84
pubmed: 23296071
J Gen Intern Med. 2009 Nov;24(11):1205-10
pubmed: 19727967
Diabetes Res Clin Pract. 2012 Oct;98(1):75-82
pubmed: 22652276
Diabetes Res Clin Pract. 2017 Oct;132:169-170
pubmed: 28962686
Diabetes Obes Metab. 2018 Sep;20(9):2159-2168
pubmed: 29732725
Diabetes Care. 2013 Sep;36(9):2628-38
pubmed: 23628621
BMJ Qual Saf. 2021 Sep;30(9):706-714
pubmed: 33542066
JAMA. 1999 Oct 20;282(15):1458-65
pubmed: 10535437
Diabetes Ther. 2021 Apr;12(4):1209-1226
pubmed: 33710520
J Res Med Sci. 2015 Nov;20(11):1112-20
pubmed: 26941817
Pharmacoepidemiol Drug Saf. 2009 Oct;18(10):973-6
pubmed: 19621344
BMC Fam Pract. 2013 Apr 04;14:47
pubmed: 23557543
BMC Health Serv Res. 2015 Jan 22;15:22
pubmed: 25608447
Saudi Pharm J. 2022 Feb;30(2):112-119
pubmed: 35528857
Diabetes Res Clin Pract. 2022 Jan;183:109119
pubmed: 34879977
J Diabetes Complications. 2010 Mar-Apr;24(2):84-9
pubmed: 19282203
Diab Vasc Dis Res. 2017 May;14(3):172-183
pubmed: 28467203
J Med Liban. 2013 Jul-Sep;61(3):127-31
pubmed: 24422361
BMJ Open Diabetes Res Care. 2019 Jul 14;7(1):e000654
pubmed: 31413840
Adv Ther. 2022 Feb;39(2):1016-1032
pubmed: 34951678
Chin Med J (Engl). 2014;127(20):3524-9
pubmed: 25316223