Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS).
OBJECTIVE
The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.


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.
Chan
Juliana C N
JC
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. jchan@cuhk.edu.hk
Gagliardino
Juan Jose
JJ
Baik
Sei Hyun
SH
Chantelot
Jean-Marc
JM
Ferreira
Sandra R G
SR
Hancu
Nicolae
N
Ilkova
Hasan
H
Ramachandran
Ambady
A
Aschner
Pablo
P
D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D003906:Developing Countries; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004651:Employment / Q000706:statistics & numerical data; D006442:Glycated Hemoglobin / Q000378:metabolism; D006706:Homeostasis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012648:Self Care
D001786:Blood Glucose; D006442:Glycated Hemoglobin