Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg.
BACKGROUND
Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians' and patients' adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients' characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented.


METHODS
The exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068).


METHODS
Seven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model.


RESULTS
In 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (-8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (OR(male): 0.87 [95%CI, 0.83-0.92]), the nationality (OR(NonEU): 0.64 [0.52-0.78]), the type of antidiabetic treatment (ORoral: 1.48 [1.35-1.63], OR(mixed): 1.35 [1.20-1.52]) and the type of treating physician (ORG-ID: 0.47 [0.42-0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria).


CONCLUSIONS
A large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients.
Centre for Health Studies, Public Research Centre for Health, Strassen, Luxembourg ; EA 4069 - Epidemiology, Assessment and Health Policies, University Paris-Descartes, Paris, France.
Laurence M
LM
Renard
Valery
V
Bocquet
Gwenaelle
G
Vidal-Trecan
Marie-Lise
ML
Lair
Claudine
C
Blum-Boisgard
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007677:Kidney Function Tests; D008074:Lipoproteins / Q000097:blood; D008189:Luxembourg; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008074:Lipoproteins; C517652:hemoglobin A1c protein, human