Multi-faceted Determinants For Achieving Glycemic Control: The International Diabetes Management Practice Study (IDMPS)

doi:10.2337/dc08-0435

Multi-faceted Determinants For Achieving Glycemic Control: The International Diabetes Management Practice Study (IDMPS)

Juliana C. N. Chan, MD (jchan{at}cuhk.edu.hk)^a,
Juan Jose Gagliardino, PhD^b,
Sei Hyun Baik, PhD^c,
Jean-Marc Chantelot, MD^d,
Sandra R. G. Ferreira, PhD^e,
Nicolae Hancu, PhD^f,
Hasan Ilkova, PhD^g,
Ambady Ramachandran, PhD^h and
Pablo Aschner, MDⁱ on behalf of the IDMPS investigators

^aDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China
^bCENEXA (UNLP-CONICET), PAHO/WHO Collaborating Centre for Diabetes, School of Medicine, National University of La Plata, La Plata, Buenos Aires, Argentina
^cDepartment of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
^dDepartment of ITC Medical Affairs, sanofi-aventis, Paris, France
^eDepartment of Preventive Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
^fDiabetes Center and Clinic, Iuliu Hatieganu University of Medicine, Cluj-Napoca, Romania
^gDepartment of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
^hIndia Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
ⁱEndocrinology Unit, Javeriana University, Bogotá, Colombia

Abstract

Objectives: The International Diabetes Mellitus Practice Study (IDMPS) is a 5-year survey documenting changes in diabetes practice in developing regions.

Research and methods: Logistic regression analysis was used to identify factors for achieving HbA_1c <7% in 11799 patients (1898 type 1 and 9901 type 2) recruited by 937 physicians from 17 countries in Eastern Europe (EE; N=3519), Asia (n=5888), Latin America (LA; N=2116) and Africa (N=276).

Results: 22% of type 1 and 36% of type 2 diabetic patients never had HbA_1c measurements. In those with values for HbA_1c, blood pressure (BP) and LDL-cholesterol (LDL-C), 7.5% of type 1 (n=696) and 3.6% of type 2 patients (n=3896) attained all 3 recommended targets (BP<130/80 mmHg, LDL-C<100 mg/dL and HbA_1c<7%). Self monitoring of blood glucose (SMBG) was the only predictor for achieving the HbA_1c goal in type 1 diabetes (odds ratios: Asia 2.24, LA 3.55 and EE 2.42). In type 2 diabetes, short disease duration (Asia 0.97; LA 0.97; EE 0.82) and treatment with few oral glucose lowering drugs (OGLD; Asia: 0.64; LA: 0.76; EE: 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in LA and Asia; health insurance coverage and specialist care in LA; lack of obesity and self-adjustment of insulin dosages in Asia; training by a diabetes educator, SMBG in patients who self-adjusted insulin and lack of macrovascular complications in EE.

Conclusions: In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control.