Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS)

Juliana C N Chan, Juan Jose Gagliardino, Sei Hyun Baik, Jean-Marc Chantelot, Sandra R G Ferreira, Nicolae Hancu, Hasan Ilkova, Ambady Ramachandran, Pablo Aschner, IDMPS Investigators, Juliana C N Chan, Juan Jose Gagliardino, Sei Hyun Baik, Jean-Marc Chantelot, Sandra R G Ferreira, Nicolae Hancu, Hasan Ilkova, Ambady Ramachandran, Pablo Aschner, IDMPS Investigators

Abstract

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 A1C <7% 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 and 36% 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 (n = 696) and 3.6% of type 2 diabetic (n = 3,896) patients attained all three recommended targets (blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring 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 glucose-lowering 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.

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Predictive factors for attaining A1C

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Predictive factors for attaining A1C

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Predictive factors for attaining A1C

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Predictive factors for attaining A1C

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Predictive factors for attaining A1C
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References
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Figure 2
Figure 2
Predictive factors for attaining A1C

Figure 3

Predictive factors for attaining A1C…

Figure 3

Predictive factors for attaining A1C

Figure 3
Predictive factors for attaining A1C
Similar articles
Cited by
References
    1. Gaede P, Lund-Andersen H, Parving HH, et al.: Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358:580–591, 2008 - PubMed
    1. Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986, 1993 - PubMed
    1. UK Prospective Diabetes Study: Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853, 1998 - PubMed
    1. Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362:1225–1230, 2003 - PubMed
    1. Narayan KMV, Gregg EW, Engelgau MM, et al.: Translation research for chronic diseases: the case for diabetes. Diabetes Care 23:1794–1798, 2000 - PubMed
Show all 16 references
Publication types
MeSH terms
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 3
Figure 3
Predictive factors for attaining A1C

References

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