Do Iranian general practitioners follow guidelines to manage type 2 diabetes?

Abstract

Background: General and family practitioners vary greatly in their clinical management of type 2 diabetes for poorly understood reasons. Objective: To explore Iranian GPs’ awareness and agreement of current diabetes guidelines and their self-reported implementation of them in clinical practice. Methods: We employed a questionnaire based on the ’awareness-to-adherence’ model of behavioural change. This questionnaire was completed by 1103 Iranian GPs who were registered by Iranian General Medical Council. Results: The mean age of participants was 41.2 (9.8) years, 61.2% were male, 63% graduated more than 10 years and only 42.3% had any CME before completing this questionnaire. Their awareness of recommendations about the control of type 2 diabetes in overall was low. Almost 32% of practitioners were aware of the guidance about HbA1c as control index of diabetes. This was almost similar for other biochemical indexes like lipid profiles FBS and normal range of SPB and DBP. Only 50% of GPs adhered to the recommendation of statin therapy in their practice. While near 75% of GPs knew the treatment of hypertension in diabetic patients, only 29% of practitioners measured blood pressure in their first visit. Overall approximately 10% were uncertain about their decision. No significant association was found among age or sex; however, year of graduation was correlated with low awareness in control of diabetes. Discussion/Conclusion: The findings of this study highlight need of appropriate actions to enhance awareness and encourage practitioners to adopt and implement in their daily practice. However, high adherence requires a reflective workforce that can respond to the scientific evidence underpinning the guidance.