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Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS).
Diabetes Care. 2009 Feb; 32(2):227-33.DC

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.

Authors+Show Affiliations

Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. jchan@cuhk.edu.hkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19033410

Citation

Chan, Juliana C N., et al. "Multifaceted Determinants for Achieving Glycemic Control: the International Diabetes Management Practice Study (IDMPS)." Diabetes Care, vol. 32, no. 2, 2009, pp. 227-33.
Chan JC, Gagliardino JJ, Baik SH, et al. Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care. 2009;32(2):227-33.
Chan, J. C., Gagliardino, J. J., Baik, S. H., Chantelot, J. M., Ferreira, S. R., Hancu, N., Ilkova, H., Ramachandran, A., & Aschner, P. (2009). Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care, 32(2), 227-33. https://doi.org/10.2337/dc08-0435
Chan JC, et al. Multifaceted Determinants for Achieving Glycemic Control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care. 2009;32(2):227-33. PubMed PMID: 19033410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). AU - Chan,Juliana C N, AU - Gagliardino,Juan Jose, AU - Baik,Sei Hyun, AU - Chantelot,Jean-Marc, AU - Ferreira,Sandra R G, AU - Hancu,Nicolae, AU - Ilkova,Hasan, AU - Ramachandran,Ambady, AU - Aschner,Pablo, AU - ,, Y1 - 2008/11/25/ PY - 2008/11/27/pubmed PY - 2009/3/12/medline PY - 2008/11/27/entrez SP - 227 EP - 33 JF - Diabetes care JO - Diabetes Care VL - 32 IS - 2 N2 - 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. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/19033410/Multifaceted_determinants_for_achieving_glycemic_control:_the_International_Diabetes_Management_Practice_Study__IDMPS__ DB - PRIME DP - Unbound Medicine ER -