Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study

Tabassum Saher; Yaser Mohammed Al-Worafi; Muhammad Nouman Iqbal; Abdul Wahid; Qaiser Iqbal; Asad Khan; Muhammad Atif; Nafees Ahmad

doi:10.3389/fmed.2022.978345

Doctors' adherence to guidelines recommendations and glycaemic control in diabetic patients in Quetta, Pakistan: Findings from an observational study

Front Med (Lausanne). 2022 Oct 31:9:978345. doi: 10.3389/fmed.2022.978345. eCollection 2022.

Authors

Tabassum Saher¹, Yaser Mohammed Al-Worafi², Muhammad Nouman Iqbal³, Abdul Wahid¹, Qaiser Iqbal⁴, Asad Khan¹, Muhammad Atif⁵, Nafees Ahmad¹

Affiliations

¹ Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan.
² Department of Clinical Sciences, College of Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates.
³ Sardarpur Rural Health Centre, Khaniwal, Pakistan.
⁴ Department of Pharmaceutics, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan.
⁵ Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.

Abstract

Background: Poor control of diabetes mellitus (DM) is partly attributed to doctors' poor adherence to guidelines.

Objective: To evaluate doctors' adherence to pharmacotherapeutic recommendations of DM management guidelines and factors associated with guidelines adherence and glycaemic control.

Methods: This prospective observational study included 30 doctors who were treating DM patients in their private clinics in Quetta, Pakistan. On visit 1, a total of 600 prescriptions written by 30 enrolled doctors (20 patients per doctor) were noted along with patients' sociodemographic and clinical characteristics. American Diabetes Association guidelines was used as a reference. The prescriptions noted were judged for guidelines compliance. Of 600 enrolled patients, 450 patients (15 patients per doctor) were followed for one more visit and included in final analysis. Glycated hemoglobin (HbA1c) level noted one visit 2 was related with the respective prescription on visit 1. Data were analyzed by SPSS (version 23). A p-value <0.05 was considered statistically significant.

Results: Patients received a median of two antidiabetic drugs (range: 1-5). A total of 73.1% patients were on polytherapy. Metformin was the most frequently prescribed (88.4%) antidiabetic followed by gliptins (46.2%). A total of 41.6% prescriptions were judged guidelines compliant. In multivariate binary logistic regressions (MVBLR) analysis, chronic kidney disease (CKD) (OR = 0.422) and polytherapy (OR = 0.367) had statistically significant negative associations (p-value <0.05) with guidelines' compliant prescriptions. The group of doctors comprised of specialists and consultants wrote significantly (p-value = 0.004) high number of guidelines adherent prescriptions (mean rank = 20.25) than the group comprised of medical officers (mean rank = 11.34). On visit 2, only 39.5% patients were on goal glycemic levels. In MVBLR analysis, suffering from dyslipidemia (OR = 0.134) and CKD (OR = 0.111), receiving sulfonylurea (OR = 0.156) and guidelines' compliant prescription (OR = 4.195) were significantly (p-value <0 .05) associated with glycemic control.

Conclusion: Although guidelines compliant prescriptions produced better glycemic control, but doctors' adherence to guidelines and glycemic control were poor. Polytherapy and CKD emerged as risk factors for guidelines divergent prescriptions. Dyslipidemia, CKD and reception of sulfonylureas had negative association with glycemic control.

Keywords: chronic kidney diseases; diabetes mellitus; glycemic control; metformin; polytherapy.