Abstract
Background
Physicians’ perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians’ perception and characteristics of adequate control of patients with diabetes.
Patients and methods
We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians.
Results
The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c <7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians’ perception and the class of HbA1c was suboptimal (κ: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively).
Conclusion
Although there is a significant physicians’ overestimation about the optimal glycemic control, this global impression and characteristics of patients’ empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets.
Acknowledgments
This registry received funds from Sanofi. The company designed the study; nonetheless, the company did not participate in the selection of patients, data capture, data analysis, manuscript draft, or the decision to summit for publication. The authors are indebted to all IDMPS-3W collaborators (in alphabetic order) as follows:
Acevedo G, Acosta I, Alpízar M, Altamirano E, Álvarez A, Álvarez P, Anaya C, Arellano S, Arreola M, Arroyo A, Arteaga V, Ascensión D, Baeza B, Bancalari C, Baqueiro J, Barón D, Barragán A, Barrientos M, Bastidas M, Bautista J, Beltrán L, Blanco A, Caballero S, Calarco E, Calderón R, Camacho L, Cano R, Caracas N, Cardoso S, Carrillo P, Carvajal M, Casco S, Castañeda R, Castelán F, Castillo O, Cerda I, Cervantes A, Chavira I, Chávez L, Chávez M, Cilia J, Cisneros H, Colín M, Collado E, Colome J, Conrado S, Correa A, Covarrubias M, Cruz E, Dávila O, De la garza N, Del pozo J, Díaz E, Domínguez C, Encinas E, Escalante A, Escalante J, Escalante M, Escudero I, Espinoza J, Estrada A, Estrada K, Fabián M, Fanghanel G, Farjat J, Fernández A, Flores M, Flores V, Franco M, Franco V, Gallardo V, Gamboa F, García P, Garcia H, Garcia J, Garcia L, Garza R, Gomez V, Gonzalez A, Gonzalez G, Gonzalez I, González A, Granillo M, Grover F, Guajardo M, Guerrero J, Gutierrez M, Guzmán A, Guzmán J, Hall J, Hamilton L, Handall V, Hernandez A, Hernandez F, Hernández A, Hernández J, Herrera L, Herrera M, Hinojos L, Ibarra A, Ibarra M, Ibáñez M, Jiménez M, Jurado M, Lavalle F, Lechuga D, Llanas D, Lopez S, López H, López R, Lozano J, Lucio F, Luna R, Macedo N, Macías A, Magallanes F, Maldonado D, Maldonado J, Mancillas L, Mar F, Marquez E, Martínez A, Martínez R, Martínez R, Matildes M, Mauricio G, Mejía A, Mejía J, Mejía L, Mejía M, Mendoza E, Mendoza P, Mercado F, Meza E, Moctezuma J, Moleres J, Monreal R, Montemayor D, Monterrubio N, Montoya J, Mora F, Morales D, Morales F, Morales M, Moreno F, Moreno L, Moreno M, Muñoz A, Muñoz T, Navalles E, Nevares L, Nevarez L, Niño J, Núñez A, Ochoa A, Olmedo V, Ortega A, Osorio D, Ovando R, Parra F, Pascoe S, Pérez C, Pérez H, Pérez N, Quezada M, Radillo P, Rajme V, Ramírez B, Ramírez J, Ramos L, Ramos M, Ríos E, Rivera E, Robles J, Rodriguez H, Rodriguez J, Rodríguez H, Rodríguez R, Romero A, Rosado C, Rosas M, Rosiles S, Rubio Y, Ruiz D, Ruiz E, Saavedra E, Salas R, Salazar H, Salinas S, Sanchez B, Sanchez H, Sanchez L, Sanchez R, Sanchez B, Sanchez S, Sandoval B, Sandoval R, Santibáñez M, Seamanduras L, Secchi N, Solís T, Sosa A, Taméz H, Tapia M, Téllez J, Torres E, Torres J, Torres P, Trasviña K, Trejo M, Triano A, Triano M, Uribe A, Vadillo M, Valdez M, Valdovinos S, Valencia H, Vales M, Valladares Z, Vargas M, Vázquez J, Vázquez P, Vidrio M, Villanueva S, Wakida H, Yamamoto J, Zamora A, and Zayas F.
Author contributions
All authors have contributed to the conception and design of the work and the analysis of the data in a manner substantial enough to take public responsibility for it; each believes the manuscript represents valid work; and each has reviewed the final version of the manuscript and approves it for publication. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
Doctor Fernando J Lavalle-González has received research grants from Sanofi; has served as a research advisor for Sanofi, Novo Nordisk, and Eli Lilly; and has received speaker honoraria from Sanofi, Novo Nordisk, and Eli Lilly.
Doctor Erwin Chiquete has received research grants from Sanofi and Grupo Ferrer; has served as a research advisor for Sanofi, Novartis, and Genzyme; and has received speaker honoraria from Novartis Mexico, Genzyme, and Grupo Ferrer. The authors report no other conflicts of interest in this work.