Multifaceted Determinants for Achieving Glycemic Control

The International Diabetes Management Practice Study (IDMPS)

  1. Juliana C.N. Chan, MD1,
  2. Juan Jose Gagliardino, PHD2,
  3. Sei Hyun Baik, PHD3,
  4. Jean-Marc Chantelot, MD4,
  5. Sandra R.G. Ferreira, PHD5,
  6. Nicolae Hancu, PHD6,
  7. Hasan Ilkova, PHD7,
  8. Ambady Ramachandran, PHD8,
  9. Pablo Aschner, MD9 and
  10. on behalf of the IDMPS Investigators*
  1. 1Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
  2. 2Center of Experimental and Applied Endocrinology, National Scientific and Technical Research Council, Pan American Health Organization/World Health Organization Collaborating Centre for Diabetes, School of Medicine, National University of La Plata, La Plata, Argentina
  3. 3Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
  4. 4Department of Intercontinental Medical Affairs, sanofi-aventis, Paris, France
  5. 5Department of Preventive Medicine, Federal University of São Paulo, São Paulo, Brazil
  6. 6Diabetes Center and Clinic, Iuliu Hatieganu University of Medicine, Cluj-Napoca, Romania
  7. 7Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
  8. 8India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
  9. 9Endocrinology Unit, Javeriana University, Bogotá, Colombia
  1. Corresponding author: Juliana C.N. Chan, jchan{at}cuhk.edu.hk

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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 25 November 2008.

  • *

    * A complete list of IDMPS investigators is available in the online appendix at http://dx.doi.org/10.2337/dc08-0435.

  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted November 6, 2008.
    • Received February 29, 2008.
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  1. Diabetes Care vol. 32 no. 2 227-233
  1. Online-Only Appendix
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