Evidence-performance gap in primary care revisited in patients with diabetes

Abstract

Evidence-performance-gaps between guidelines and treatment of type 2 diabetes (T2DM) in daily practice have been reported, especially in primary care. We aimed to assess the potential gap comparing current treatment in primary care with guidelines and patients’ characteristics from large clinical trials that guidelines are based on, namely UKPDS, ACCCORD, ADVANCE, STENO-2 and VADT. Methods: We undertook a cross-sectional study and extracted data on 541 patients with T2DM from a clinical information system of a GP network in Switzerland. Results: Our study population was comparable to patients in ACCORD, ADVANCE and VADT at baseline. Patients in UKPDS and STENO-2 differed in age and disease duration. HbA1c-levels (7.3%), LDL-level (2.6 mmol/l), systolic and diastolic (135/78 mmHg) blood pressure were lower in our study than in the reference studies. 39.4% received an ACE-inhibitor, 41.6% statins and 41.4% aspirin. Conclusion: Taking into consideration the results of recent large clinical trials indicating that very strict treatment goals are of no additional benefit, most patients in Swiss primary care would not benefit from a treatment intensification regarding HbA1c, blood pressure and cholesterol targets. Evidence-performance-gaps were observed mainly concerning the choice of first line medication.