Abstract
Objective To assess factors associated with adherence to clinical practice guidelines (CPGs) for type 2 diabetes mellitus (T2DM). Methods A cross-sectional multicenter study based on a two-round Delphi survey was designed. A total of 98 endocrinologists (mean age 45 years) involved in the care of T2DM patients completed a 43-item questionnaire assessing different aspects of adherence related to CPGs. Results Most participants worked in tertiary care public hospitals. All participants used CPGs, with ADA/EASD as the most common (99%). The lack of time, establishment of an individualized management of patients, insufficient human resources, and therapeutic inertia were scored as the main reasons for not following CPGs recommendations. Participants agreed that insufficient material resources and limitations established by the healthcare system prevent adherence to CPGs. The risk of hypoglycemia was considered to be limiting factor for the patients' integral control. Also, there was consensus on the need to have the support of nursing personnel with specific training in diabetes as well as dietitians and podiatrists. There was disagreement regarding the influence on adherence to CPGs of patient's characteristics not matching those of CPGs, patient's preferences, tolerability of the action recommended, concomitant comorbidities, or pluripathological conditions. Differences according to the participant's age (≤40 years vs. >40 years) were not found. Therapeutic inertia and lack of time did not show a significant correlation. Conclusions Nonadherence to CPGs on T2DM is a multifactorial problem but the existence multiple CPGs, the lack of time, the therapeutic inertia, and insufficient human resources have been identified as factors limiting adherence. Hypoglycemia continues to be a barrier for achievement of targets recommended by CPGs.
Highlights
Diabetes mellitus (DM) is a complex multisystemic disease that requires high quality care, increases the risk of potentially life-threatening complications, and imposes a high impact on healthcare services and a heavy economic burden on society [1,2,3]
Participation in a training program on diabetes and in a research program in the previous 12 months was reported by 78.6% and 53.1% of participants, respectively
67.3% reported that they had attended between 76 and 150 patients in the last week, and that more than 25% of patients were diagnosed with type 2 diabetes mellitus (T2DM) according to 69.4% of participants
Summary
Diabetes mellitus (DM) is a complex multisystemic disease that requires high quality care, increases the risk of potentially life-threatening complications, and imposes a high impact on healthcare services and a heavy economic burden on society [1,2,3]. The pathogenesis and long-term metabolic and vascular complications of type 2 diabetes (T2DM) are fairly well known but its treatment has remained challenging, with only half of the patients achieving the recommended HbA1c target, and a significant proportion of the diabetic population. Clinical practice guidelines (CPGs) provide comprehensive evidence-based recommendations based on randomized controlled trials (RCTs) for all relevant aspects of DM, including diagnosis and treatment of type 1 and type 2 in children and adults, strategies for the prevention or delay of T2DM, and therapeutic approaches that can reduce morbidity, in particular, the risk of renal and cardiovascular complications, and improve patient outcomes [6,7,8,9,10,11]. It has been emphasized that it is essential to recognize the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines [24], which will help to design and implement appropriate strategies for effective and improved diabetes guidelines adherence and management
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