CONICET | Buscador de Institutos y Recursos Humanos

OBJECTIVE The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions. RESEARCH DESIGN AND METHODS Logistic regression analysis was used to identify factors for achieving A1C7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (n 3,519), Asia (n 5,888), Latin America (n 2,116), and Africa (n 276). RESULTS Twenty-two percent of type 1 diabetic and36%of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n696) and 3.6% of type 2 diabetic (n3,896) patients attained all three recommended targets (blood pressure 130/80 mmHg, LDL cholesterol 100 mg/dl, and A1C 7%). Selfmonitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucoselowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe. CONCLUSIONS In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control. The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions. RESEARCH DESIGN AND METHODS Logistic regression analysis was used to identify factors for achieving A1C7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (n 3,519), Asia (n 5,888), Latin America (n 2,116), and Africa (n 276). RESULTS Twenty-two percent of type 1 diabetic and36%of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n696) and 3.6% of type 2 diabetic (n3,896) patients attained all three recommended targets (blood pressure 130/80 mmHg, LDL cholesterol 100 mg/dl, and A1C 7%). Selfmonitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucoselowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe. CONCLUSIONS In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control.