The treatment of patients with insulin-requiring diabetes mellitus by primary care physicians.
The extent to which a sample of community based, primary care physicians follow current standards of care for the treatment of non-obese, insulin-requiring patients as defined and recently published by the American Diabetes Association (ADA) was studied. A total of 212 physicians responded with 191 indicating that they treat one or more non-obese, insulin-requiring patients. Of this sample, 97% used multiple injection, mixed insulin regimens. However, over 70% also used single injection regimens. Whereas 94% prescribed self-monitoring blood glucose (SMBG), only 31% did so for more than 75% of their patients and 37% did so for less than 50%. Twenty-five percent of respondents did not obtain HbA1 values on their patients. For respondents who do collect HbA1, only 28% did so for over 75% of their patients and 30% for less than 50%. Physicians with fewer patients were more likely to prescribe single injection insulin regimens (P = .02). Recent graduates from medical school also used HbA1's more frequently than earlier graduates (p = .001). These data suggest that while care practices recommended by the ADA are being implemented by primary care physicians, they are significantly underutilized.
Marrero
D G
DG
Indiana University School of Medicine, Indianapolis 46202.
Moore
P S
PS
Fineberg
N S
NS
Langefeld
C D
CD
Clark
C M
CM
D000328:Adult; D015190:Blood Glucose Self-Monitoring; D002985:Clinical Protocols; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000145:classification / Q000627:therapeutic use; D016017:Odds Ratio; D010821:Physicians, Family; D012044:Regression Analysis
D006442:Glycated Hemoglobin; D007328:Insulin