Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study

Nikolaos Papanas; Moses Elisaf; Kalliopi Kotsa; Andreas Melidonis; Stavros Bousboulas; Alexandra Bargiota; Emmanouel Pagkalos; John Doupis; Ioannis Ioannidis; Iakovos Avramidis; Angelos C Pappas; Gerasimos Karousos; Eleni Arvaniti; Magdalini Bristianou; Katerina Pietri; Eugenia Karamousouli; Bernd Voss; Ilias Migdalis; Nikolaos Tentolouris

doi:10.1007/s13300-020-00935-6

Adherence to the National Guidelines for Follow-Up Protocol in Subjects with Type 2 Diabetes Mellitus in Greece: The GLANCE Study

Diabetes Ther. 2020 Dec;11(12):2887-2908. doi: 10.1007/s13300-020-00935-6. Epub 2020 Oct 3.

Authors

Nikolaos Papanas¹, Moses Elisaf², Kalliopi Kotsa³, Andreas Melidonis⁴, Stavros Bousboulas⁵, Alexandra Bargiota⁶, Emmanouel Pagkalos⁷, John Doupis⁸, Ioannis Ioannidis⁹, Iakovos Avramidis¹⁰, Angelos C Pappas¹¹, Gerasimos Karousos¹², Eleni Arvaniti¹³, Magdalini Bristianou¹⁴, Katerina Pietri¹⁵, Eugenia Karamousouli¹⁵, Bernd Voss¹⁶, Ilias Migdalis¹⁷, Nikolaos Tentolouris¹⁸

Affiliations

¹ Diabetes Centre, Second Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. papanasnikos@yahoo.gr.
² Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
³ Division of Endocrinology and Metabolism-Diabetes Centre, First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece.
⁴ Diabetes Centre, General Hospital "Tzanio", Piraeus, Greece.
⁵ Diabetes Centre, General Hospital "Agios Panteleimon", Piraeus, Greece.
⁶ Department of Endocrinology and Metabolic Diseases, University Hospital of Larissa, Thessaly, Greece.
⁷ Diabetes Department, Clinic "Thermi", Thessaloniki, Greece.
⁸ Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Salamina, Greece.
⁹ First Department of Internal Medicine, Konstantopouleio Hospital, Athens, Greece.
¹⁰ Internal Medicine Department and Diabetes Centre, George Papanikolaou" General Hospital, Thessaloniki, Greece.
¹¹ Diabetes Centre, Venizelio General Hospital Heraklion, Heraklion, Crete, Greece.
¹² Department of Internal Medicine and Diabetes, Athens Medical Group, Psychiko, Athens, Greece.
¹³ General Hospital of Ioannina "G. Hatzikosta", Ioannina, Greece.
¹⁴ Department of Internal Medicine, General Hospital of Lamia, Lamia, Greece.
¹⁵ Merck Sharp and Dohme (MSD), A1, Athens, Greece.
¹⁶ Merck Sharp and Dohme (MSD) RBSC GmbH, Haar, Germany.
¹⁷ Second Medical Department and Diabetes Centre, NIMTS Hospital, Athens, Greece.
¹⁸ First Department of Propaedeutic Internal Medicine, Laiko General Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.

Abstract

Introduction: Physician adherence, or lack therefore, to diabetes care and follow-up guidelines may be linked to the rates of achieving suboptimal glycaemic, blood pressure and lipid targets in people with type 2 diabetes mellitus (T2DM). In this cross-sectional study we evaluated physician adherence to the patient follow-up protocol (PFP) of the 2017 Hellenic Diabetes Association (HDA) guidelines and also assessed glycated haemoglobin (HbA_1c), blood pressure and lipid control achievement rates in the routine care setting in Greece.

Methods: Eligible subjects were adults with T2DM receiving oral hypoglycaemic agents (OHAs) for ≥ 1 year who had ≥ 2 HbA_1c measurements in the previous year and an HbA_1c target < 7%. Overall adherence at the subject level was defined as the percentage of the 62 HDA PFP items that had been met during the past year.

Results: Between June and December 2018, 601 eligible subjects (54.6% men; mean age 65.2 years; median T2DM duration 5.9 years, of whom 96.5% had ≥ 1 medical condition/comorbidity), were enrolled into the study by 53 hospital- and office-based endocrinologists, internists and general practitioners. The main OHAs prescribed at enrolment were metformin (91.0%), dipeptidyl peptidase-4 inhibitors (60.7%), sodium-glucose co-transporter-2 inhibitors (23.5%) and sulphonylureas (16.3%). Mean overall physician adherence to the PFP was 43.6%. Predictors of greater higher physicans' adherence were female sex (p = 0.026), > 3 medical conditions/comorbidities (p = 0.043) and diabetic complications (p < 0.001). HbA_1c, low-density lipoprotein-cholesterol, systolic/diastolic blood pressure and composite metabolic targets were achieved by 82.1, 57.0, 42.6 and 21.6% of subjects, respectively.

Conclusions: In Greek routine care, physician adherence to the PFP of the 2017 HDA guidelines is suboptimal. Future efforts should focus on identifying the barriers to an adequate adherence by physicians to the full PFP, with the aim to provide optimal patient care.

Keywords: Follow-up; Glycated haemoglobin A1c; Guideline adherence; Target attainment; Type 2 diabetes mellitus.