ATTITUDES AND BEHAVIORS OF PRIMARY CARE PHYSICIANS REGARDING TIGHT CONTROL OF BLOOD-GLUCOSE IN IDDM PATIENTS

OBJECTIVE - To evaluate attitudes and practices of primary-care physic ians toward tight blood glucose control in IDDM. RESEARCH DESIGN AND M ETHODS - A mail and telephone questionnaire survey was conducted on a systematic, stratified sample of 1429 family-practice physicians, gene ral practitioners, internists, and pediatricians in active practice in the United States who treated patients with IDDM. Physicians were ask ed about methods they used for clinical and laboratory assessment of b lood glucose control and about their attitudes and beliefs in treating IDDM. They were asked also what they consider to be acceptable ranges for blood glucose and HbA1 in IDDM patients. A score was developed re flecting three criteria for tight blood glucose control: fasting gluco se 70-120 mg/dl (3.9-6.7 mM), 2-h postprandial glucose < 180 mg/dl (< 10 mM), and HbA1 less-than-or-equal-to 8% the nondiabetic value was sp ecified as 5-7%). Physicians were accorded one point when their accept able range agreed with an intensive treatment criterion (range for sco re 0-3). RESULTS - Only 3 1% of physicians agreed with all three crite ria for tight control of blood glucose; 37% agreed with none or only o ne of the standards. Pediatricians were particularly low in their agre ement with the HbA, standard. Physicians who agreed with one of the th ree criteria often did not agree with the other two. With increasing v alue for the score, there was a greater proportion of physicians whose management practices (e.g., frequent measurement of HbA1, multiple in sulin injections, patient SMBG, use of dietitian/educator in care of p atients) are conducive toward tight control of blood glucose. However, even among physicians with a score of 3, HbA, was ordered infrequentl y, three or more insulin injections/day was prescribed rarely, patient SMBG was less than fully endorsed, and both a dietitian and diabetes educator were used by a minority of physicians. CONCLUSIONS - it appea rs that primary-care physicians are not fully aware of recommended cri teria for intensive treatment of blood glucose in IDDM patients or of the importance of multiple insulin injections, use of HbA1, and patien t SMBG. Physician practice behaviors are less than optimal for intensi ve management of IDDM patients, even among physicians who agree with a ll three standards for intensive treatment of blood glucose in IDDM.