Should we care to adhere? Guideline adherence rates, glycemic control and physician perspective on adherence for type-2 diabetes

Abstract

Despite increasing knowledge, treatment options and funding, the number of type-2 diabetes mellitus (T2DM) patients who achieve their glycemic targets has not increased in the past 2 decades. Medical guidelines aim for favorable outcomes, but adherence to T2DM guidelines is low. Our analysis evaluates T2DM guideline adherence for Germany, its associations with glycemic target achievement and physicians’ perspectives on adherence. In this observational study, 108 T2DM patients in diabetology specialist care, receiving initial or adjusted insulin therapy, were included in the analysis. Guideline adherence was assessed for four areas of the German national treatment guideline (NVL): (1) completing 12 disease monitoring tasks, (2) screening for 5 diabetes comorbidities and complications, (3) treatment targets in 5 dimensions and (4) adherence to the therapy algorithm along the patient pathway. Glycemic target achievement was assumed when the last HbA1c measurement was ≤ the individual HbA1c target. Physicians’ opinion on guideline adherence (importance for treatment success, ease of implementation) was gathered through a survey. Adherence rates to the four NVL areas were 44%–92%. Forty-three percent of participants achieved their HbA1c target. Participants treated adherent to 2+ or 3+ NVL areas had higher rates of target achievement than the counter groups (chi2 = 3.280/2.738, p = 0.070/0.098). There was strong consensus between physicians about the relevance of each NVL area. Patients with T2DM benefit from comprehensive guideline-adherent treatment. A study with larger sample size is required to confirm results. Digital tools can facilitate embedding of guideline information into daily clinical practice.