The relationship between physicians' self-reported target fasting blood glucose levels and metabolic control in type 2 diabetes - The QuED Study Group - Quality of care and outcomes in type 2 diabetes

OBJECTIVE - To investigate the relationship between beliefs of physicians r elative to intensive metabolic control in type 2 diabetes and levels of HbA (1c) obtained in a sample of their patients. RESEARCH DESIGN AND METHODS - Physicians' beliefs were investigated through a questionnaire sent to a sample of self-selected clinicians participating in a nationwide initiative aimed at assessing the relationship between the quality of care delivered to patients with type 2 diabetes and their outco mes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (< 65 vs. <greater than or equal to> 65 years). Mean HbA(1c) levels in the study population were th us evaluated according to target fasting blood glucose (FBG) used by their physicians. RESULTS - Of 456 physicians, 342 (75%) returned the questionnaire. Among th e responders, 200 diabetologists and 99 general practitioners (GPs) recruit ed 3,297 patients; 2,003 of whom were always followed by the same physician and 1,294 of whom were seen by different physicians in the same structure on different occasions. Only 14% of the respondents used target FBG levels less than or equal to6.1 3mmol/l, whereas 38% pursued values >7.8 mmol/l, w ith no statistically significant difference between diabetoloiogists and GP 5. The analysis of the relationship between FBG targets and metabolic contr ol, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA(1c) values of 7.0 +/- 1.6 for pa tients in the charge of physicians pursuing FBG levels less than or equal t o6.1 mmoil and 7.8 +/- 1.8 for those followed by physicians who used target values >7.8 mmol/l. After adjusting for patients' and physicians' characte ristics, the risk of having Hb(a1) values >7.0% was highly correlated with physicians' beliefs. Patients followed by different physicians in the same unit showed a risk of inadequate metabolic control similar to that of patie nts followed by physicians adopting a nonaggressive policy. CONCLUSIONS - Doctors adopt extremely heterogeneous target FBG levels in pa tients with type 2 diabetes, which in turn represent an important independe nt predictor of metabolic control. To improve patient outcomes, physicians- centered educational activities aimed at increasing the awareness of the po tential benefits of a tight metabolic control in patients with type 2 diabe tes are urgently needed.