title: Patterns of diabetes care in Slovenia, Croatia, Serbia, Bulgaria and Romania : An observational, non-interventional, cross-sectional study.
abstract: BACKGROUND
  National guidelines for treating type 2 diabetes in the Balkans generally follow European guidelines. The current study was undertaken to estimate the rate of glycated hemoglobin (HbA1c) measurements and level of HbA1c control in diabetic patients treated in regular clinical practice settings in the Balkans and to evaluate if providing HbA1c measurements improves adherence to treatment guidelines.
  
  
  METHODS
  This cross-sectional study enrolled type 2 diabetic patients treated by 79 primary care physicians and 102 specialists. The participants were provided with HbA1c measuring devices to measure HbA1c during regular office visits and a physician survey evaluated HbA1c the results feedback. Relevant clinical, demographic, drug treatment and specialist referral data were extracted from patient charts. Descriptive statistics and stepwise multivariate regression analysis were used.
  
  
  RESULTS
  Among 1853 patients included (average age 63.5 ± 10.7 years, 51% male) the average diabetes duration was 8.9 ± 7.1 years, 40% of patients had HbA1c measured every 6 months and 34% every 12 months (or less frequently). The rate of 6‑month measurement was higher among specialists (43%) vs. primary care physicians (32%, p < 0.01). The average HbA1c was 7.3 ± 1.5 and 35% of patients achieved the target HbA1c level of < 6.5%. Metformin monotherapy was prescribed to 28% of patients and metformin + sulphonylurea to 23%, 55% of patients on metformin monotherapy and 32% of patients on dual therapy metformin + sulphonylurea achieved the target HbA1c < 6.5%. Treatment remained unchanged in 91% and was stepped up in only 7.2% of patients. Physicians were not surprised (in 79% of patients) or were pleasantly surprised (in 11%) by the HbA1c results at the time of visit. Average diabetes duration and patient use of home glucometers were associated with the level of disease control.
  
  
  CONCLUSIONS
  The rates of HbA1c measurements remain low in the Balkans, although higher among specialists. Over 60% of patients, mostly treated with traditional oral antidiabetics did not achieve disease control. Providing convenient HbA1c measurement devices was not associated with a marked change in diabetes management. Future research is needed to evaluate the impact of these treatment patterns on long-term outcomes and costs to society.
authors.affiliation: Department for Endocrinology and Diabetes, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia. miro.cokolic@ukc-mb.si.
authors.forename: Miro
authors.identifier: http://orcid.org/0000-0002-9933-3598
authors.initials: M
authors.lastname: Cokolic
authors.affiliation: Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Nebojsa M
authors.initials: NM
authors.lastname: Lalic
authors.affiliation: Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Dragan
authors.initials: D
authors.lastname: Micic
authors.affiliation: Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", Clinical Hospital Centre "Sisters of Mercy", Zagreb, Croatia.
authors.forename: Gorana
authors.initials: G
authors.lastname: Mirosevic
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolic Disorders, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Klobucar Majanovic
authors.affiliation: Diagnostic Consultative Center XII, Sofia, Bulgaria.
authors.forename: Ivaylo N
authors.initials: IN
authors.lastname: Lefterov
authors.affiliation: Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Mariana
authors.initials: M
authors.lastname: Graur
mesh_terms: D002031:Bulgaria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012383:Romania / Q000453:epidemiology; D055771:Serbia / Q000453:epidemiology; D017524:Slovenia / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Clinical practice; Diabetes therapy; Glycemic control; HbA1c measurement rate; Type 2 diabetes