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

  1. The QuED Study Group Writing Committee Coordinating Center:,
  2. Maurizio Belfiglio, MD1,
  3. Giorgia De Berardis, MSC (chem)1,
  4. Monica Franciosi, MSC (biol)1,
  5. Donatella Cavaliere, MD1,
  6. Barbara Di Nardo, HSDIP1,
  7. Sheldon Greenfield, MD2,
  8. Sherrie H. Kaplan, PHD, MPH2,
  9. Fabio Pellegrini, MS1,
  10. Michele Sacco, MD1,
  11. Gianni Tognoni, MD1,
  12. Miriam Valentini, MD1,
  13. Antonio Nicolucci, MD1,
  14. Scientific Committee:,
  15. Vittorio Caimi, MD3,
  16. Fabio Capani, MD4,
  17. Andrea Corsi, MD5,
  18. Roberto Della Vedova, MD3,
  19. Massimo Massi Benedetti, MD6,
  20. Antonio Nicolucci, MD1,
  21. Claudio Taboga, MD7,
  22. Massimo Tombesi, MD3 and
  23. Giacomo Vespasiani, MD8
  1. 1Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
  2. 2TUFTS University, Boston, Massachusetts
  3. 3Centro Studi e Ricerche in Medicina Generale, Monza, Italy
  4. 4University of Medicine of Chieti and Diabetes Outpatient Clinic, General Hospital, Pescara
  5. 5Diabetes Outpatient Clinic, General Hospital, Arenzano
  6. 6Insitute of Internal Medicine, Endocrine and Metabolic Science, University of Perugia, Perugia
  7. 7Diabetes Outpatient Clinic, General Hospital, Udine
  8. 8Diabetes Outpatient Clinic, General Hospital, S. Benedetto del Tronto, Italy

    Abstract

    OBJECTIVE—To investigate the relationship between beliefs of physicians relative to intensive metabolic control in type 2 diabetes and levels of HbA1c 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 outcomes. At the same time, physicians were asked to collect clinical data on a random sample of their patients, stratified by age (<65 vs. ≥65 years). Mean HbA1c levels in the study population were thus evaluated according to target fasting blood glucose (FBG) used by their physicians.

    RESULTS—Of 456 physicians, 342 (75%) returned the questionnaire. Among the responders, 200 diabetologists and 99 general practitioners (GPs) recruited 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 ≤6.1 mmol/l, whereas 38% pursued values >7.8 mmol/l, with no statistically significant difference between diabetologists and GPs. The analysis of the relationship between FBG targets and metabolic control, restricted to those patients always seen by the same physician, showed a strong linear association, with mean HbA1c values of 7.0 ± 1.6 for patients in the charge of physicians pursuing FBG levels ≤6.1 mmol/l and 7.8 ± 1.8 for those followed by physicians who used target values >7.8 mmol/l. After adjusting for patients’ and physicians’ characteristics, the risk of having HbA1c 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 patients followed by physicians adopting a nonaggressive policy.

    CONCLUSIONS—Doctors adopt extremely heterogeneous target FBG levels in patients with type 2 diabetes, which in turn represent an important independent predictor of metabolic control. To improve patient outcomes, physicians-centered educational activities aimed at increasing the awareness of the potential benefits of a tight metabolic control in patients with type 2 diabetes are urgently needed.

    Footnotes

    • Address correspondence and reprint requests to Antonio Nicolucci, MD, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy. E-mail: nicolucc{at}cmns.mnegri.it.

      Received for publication 12 June 2000 and accepted in revised form 15 November 2000.

      A full list of investigators is listed in an appendix at the end of this article.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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    1. doi: 10.2337/diacare.24.3.423 Diabetes Care March 2001 vol. 24 no. 3 423-429
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