Care of patients with type II diabetes: a study of family physicians' compliance with clinical practice guidelines.
BACKGROUND
Most patients with type II diabetes mellitus receive care by family physicians. The goals of this study were to determine the level of diabetes care provided by family physicians; to assess family physicians' compliance with the Canadian Diabetes Association (CDA) guidelines; and to examine relationships between various aspects of diabetes care and glycemic control.


METHODS
A retrospective medical chart review was conducted of 118 patients with type II diabetes mellitus in 10 family practice clinics in Newfoundland. The study population consisted of 55 male and 63 female patients with a mean age of 64 (range 29 to 88) years. Using standardized forms based on the CDA guidelines, information about plasma glucose and lipid levels, presence of diabetes complications, and physician management practices were extracted from patient charts. The main outcome measure was glycosylated hemoglobin (HbA1c) levels.


RESULTS
Only 53% patients had HbA1c measurements done in the previous year; these persons had a significantly longer duration of diabetes that those who did not have their HbA1c measured. Eighty-seven percent of patients had optimal or good plasma glucose levels. Compliance with CDA guidelines by physicians was poor; physicians were doing about half the recommended checks and procedures.


CONCLUSIONS
Data from the present study seem to suggest that family physicians are doing a good job of providing care for their patients with type II diabetes. The results, however, should be interpreted with caution until further research is done to replicate our findings because of the limitations of this small retrospective study.
Worrall
G
G
Memorial University of Newfoundland, Centre for Rural Health Studies, Whitbourne. gworrall@morgan.ucs.mun.ca
Freake
D
D
Kelland
J
J
Pickle
A
A
Keenan
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009523:Newfoundland and Labrador; D010821:Physicians, Family / Q000592:standards; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D014837:Voluntary Health Agencies
D006442:Glycated Hemoglobin; D008055:Lipids