Results of the International Diabetes Management Practices Study (IDMPS), year 2: pattern of care in patients with type 1 diabetes

CHAN J; GAGLIARDINO JJ; ON BEHALF OF THE LDMPS GROUP

Amsterdam

Congreso; 43rd EASD Annual Meeting of the European Association for the Study of Diabetes; 2007

European Association for the Study of Diabetes

Background and Aims: Despite the findings of the DCCT, comparing intensive to conventional treatment, and the recommendations of the ADA, EASD and IDF, a large number of patients with diabetes are not well controlled, emphasizing the need  for implementation of measures designed to improve the quality of diabetes care. In this regard, our aim was to gather data on current practices in the management of patients with diabetes worldwide and to evaluate the degree of compliance with international guidelines. Material and Methods: The IDMPS is an international, multicenter, observational study performed in 27 countries within Africa, Asia, Eastern Europe, the Middle East and Latin America. Data are being collected from patients with Type 1 and Type 2 diabetes (¡Ã18years), seen in current medical practice in l-year cycles (a 2-week cross-sectional recruitment period, followed by a 9-month longitudinal period for Type 2 patients) for 5 years. Here, we report results for patients with Type 1 diabetes collected during  the second cross-sectional period (Year 2) in 8 countries. In addition to monitoring HbA1 and FBG, information about insulin self-injection, selftitration, diabetes education and frequency of visits to their physician was collected. Data were analyzed using standard descriptive methods. Results: 940 patients with Type 1 diabetes (50.5% men; mean age: 34.1¡¾12.6 years) were recruited during November and December 2006. The mean BMI was 24.0¡¾3.9 kg/m2 for  men and 24.0¡¾4.8 kg/m2 for women. In the past 3 months, patients had visited a specialist in diabetes 1.3¡¾1.4 (median: 1.0) times and a GP 1.0¡¾1.5 (median: 0; range: 0-12) times. Diabetes education was provided by diabetes educators to 52.2% of patients. 2.3¡¾2.1 times (median: 2.0) within the last 12 months. Overall, 86.8% of patients had HbA1 tested at least once with a mean of 2.0¡¾1.1 (median: 2.0) tests within the past year; the mean time elapsed since last HbA1c measurement was 3.8¡¾7.7 (median: 1.0) months. The mean last available HbA1c was 8.3¡¾2.0%. 24.4% of patients had an HbA1c <7%. 27.6% between 7% and 8%, and 48% >8%. Self-injection of insulin was reported in 93.5% of patients and self-titration in 66.2%, 28.7% of patients were considered to be on target according to the physician, and among these the mean HbA1c was 7.0¡¾1.6%. Laboratory testing for FBG was performed 5.8¡¾10.4 (median: 3.0) times/year. The mean last available FBG (laboratory) was 163.0¡¾78.6 mg/dL and 17.2% had a FBG ¡Â100 mg/dL; 75.4% of patients had a glucometer at home, and 76.7% selfmonitored their blood glucose (SMBG). FBG was monitored by SMBG 15.9¡¾15.1 (median: 10.0) times/month and post-prandial glucose 12.8¡¾15.8 (median: 7.0) times/month. The use of SMBG was associated with a higher number of patients reaching target according to the investigator (84.6% vs.15.4%). SMBG and the investigator¢¥s statement that the patient had reached target were associated with a better glycemic control in terms of laboratory HbA1c and FBG values. Conclusion: Our data show that patients with Type 1 diabetes are poorly controlled (in terms of HbA1c and FBG), despite being monitored regularly for their condition. This suggests that improvement of education and commitment of both patients and their providers is necessary to achieve a more interactive and effective care provision to these patients. Supported by an unrestricted grant from sanofi-aventis