Results of the InternationaI Diabetes Management Practices Study (IDMPS), year 2: baseline characteristics and treatment regimens in patients with type 1 diabetes

ASCHNER P; 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 (¡Ã18 years), seen in current medical practice in l-year cycles (a 2-week cross-sectional recruitmenl 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. Data were analyzed using standard descriptive methods. Results: Overall, 940 patients (50.5% men) with Type 1 diabetes were recruited during November and December 2006. The mean age was 34.1¡¾12.6 years, mean BMI 24.0¡¾3.9 kg/m2 for men and 24.0¡¾4.8 kg/m2 for women, and mean disease duration 11.8¡¾9.0 years. The mean last availab1e HbA1c was 8.3¡¾2.0%; 24.4% of the patients had an HbA1c <7%. Mean last available FBG (Iaboratory) was 163.0¡¾78.6 mg/dL. ¢¥Ihe mean systolic/diastolic blood pressure was 120/74 mmHg. Target treatment levels were achieved for LDL (<100 mg/dL) in 43.3% of patients, for HDL (>40 mg/dL) in 75.8%, and for triglyceride (<150 mg/dL) in 81.0% of patients. The mean time since start of insulin therapy was 10.8¡¾8.5 years and the mean daily dose was 0.75¡¾0.30 U/kg. A basal + prandial insulin regime was used in 56.1% of patients with a mean daily dose of 0.82¡¾0.29 U/kg (0.39¡¾0.21 U/kg for basal insulin and 0.43¡¾0.21 U/kg for prandial insulin); mean HbA1c was 8.3¡¾2.0%. Premixed insulin alone was used in 22.3% of patients with a mean daily dose of 0.68¡¾0.27 U /kg; mean HbA1c was 8.3¡¾2.1 %. Only 14.0% of patients were using basal insulin alone (mean daily dose: 0.53¡¾0.28 U/kg; mean HbA1c: 8.5¡¾2.1%) and 0.7% prandial insulin alone (mean daily dose 0.49¡¾0.19 U/kg; mean HbA1c:7.9+1.4%). Among patients with HbA <7%,904% were treated with basal insulin alone, 61.3% with basal+prandial insulin, 0.6% with prandial insulin alone and 23.2% with premixed insulin alone. Conclusion: The analysis of data from the second cross-sectional period of the IDMPS (Year 2), shows that the majority of Type 1 patients analyzed did not achieve the recommended treatment goals for HbA1c and FBG. Thus, measures designed to improve these results, probably related to overall education of patients and members of the health care team, are urgently needed to reduce the current and future increases in the demand for care and the costs resulting from this poor diabetes control worldwide. Supported by an unrestricted grant from sanofi-aventis