Écarts entre le référentiel et la pratique dans le diabète de type 2: Les préjugés des médecins et des patients sont un obstacle à une éducation efficace des patients

Abstract

Health insurance data show that general practitioners (GPs) do not strictly apply clinical practice guidelines for the management of patients with type 2 diabetes.The Health insurance fund of the Centre region assessed doctors' practices in diabetes management and found sharp disparities. Our study sought to explain these differences by questioning (through interviews and questionnaires) a cross-section of GPs and patients with diabetes.Interviews and questionnaires show that doctors are well aware of the recommendations for follow-up and generally agree with them. Their systematic application, however, runs up against the concrete conditions of daily practice, especially in terms of diabetes education.GPs see the management of patients with diabetes as a combination of their own skills (decisions and advice) and of responsible patient behavior. Our results, however, suggest that GPs fail to counsel their patients properly because they cannot communicate to their patients the importance of diet and physical activity. Optimum management requires that doctors develop a cooperative relation with other health professionals and improve the patient-doctor relation to promote patients' understanding of the principles of their treatment and help them to accept responsibility for managing their disease.