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The management of Type 2 diabetes: A survey of Australian general practitioners

Published:December 07, 2011DOI:https://doi.org/10.1016/j.diabres.2011.11.004

      Abstract

      Objective

      To explore how clinical and demographic variables impact on the management of diabetes mellitus in general practice.

      Design

      A structured vignette survey was conducted in Australia. This included nine vignettes chosen at random from 128 developed around seven clinical variables. Respondents were asked to recommend a change in treatment and make specific recommendations. A random sample of general practitioners (GPs) were recruited. Two diabetologists involved in the development of national guidelines also participated.

      Results

      125 (13.8%) GPs participated. Statistical analyses were used to generate outcome measures. GPs recommended a change in treatment for most (81.1%) cases; were less likely to prescribe a statin (68.5% GPs vs. 76.3% diabetologists), less likely to treat hypertension (66.7% vs.89%) and less likely to refer for lifestyle modification (82.3% vs. 96.5%). Significant disagreement occurred around prescribing or changing oral hypoglycaemics. No GP characteristics showed significant impact. The proportion of GPs who agreed with diabetiologists on dose and choice of drugs was 35.7% for statins, 49.6% for antihypertensives and 39.6% for oral hypoglycaemics.

      Conclusions

      There were significant differences between diabetologists and GPs on the management of diabetes. The survey suggests significant under-dosing by GPs. These findings warrant further investigation.

      Keywords

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      References

      1. AIHW Diabetes. http://www.aihw.gov.au/diabetes/ [viewed 8.07.11].

        • Reddy P.
        • Ford D.
        • Dunbar J.A.
        Improving the quality of diabetes care in general practice.
        Aust J Rural Health. 2010; 18: 187-193
        • Jiwa M.
        • Freeman J.
        • Fisher C.
        • Schrecker G.
        • Gordon M.
        • Reed J.
        Factors that impact on the application of guidelines in general practice: a review of medical records and structured investigation of clinical incidents in hypertension.
        Qual Prim Care. 2005; 13: 215-222
        • Jiwa M.
        • McGowan K.
        • Freeman J.
        • Gordon M.
        Hypertension and the older patient in general practice. A comparison of process and outcome for patients on multiple therapies at two practices.
        Qual Prim Care. 2004; 12: 243-249
        • Glasziou P.
        • Haynes B.
        The paths from research to improved health outcomes.
        Evid Based Med. 2005; 10: 4-7
        • Porter C.
        • Greenfield C.
        • Larson A.
        • Gilles M.
        • Improving G.P.
        diabetes management – A PDSA audit cycle in Western Australia.
        Aust Fam Physician. 2009; 38: 939-944
        • Parving H.H.
        • Lewis J.B.
        • Ravid M.
        • Remuzzi G.
        • Hunsicker L.G.
        Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective.
        Kidney Int. 2006; 69: 2057-2063
        • Kirwan J.R.
        • Chaput de Saintonge D.M.
        • Joyce C.R.
        Clinical judgment analysis.
        Q J Med. 1990; 76 ([Review]): 935-949
        • Babbie E.
        Survey research in the practice of social science.
        Wadsworth Publishing, Belmont1996
      2. Doctor's list AMPCo Direct. Available from: http://www.ampcodirect.com.au/DynamicPages.asp?cid=11&navid=2 [accessed April 2010].

        • West P.
        Reproducing naturally occurring stories: Vignettes in survey research.
        MRC Medical Sociology Research Unit, Glasgow1982
      3. National Health Medical Research Council. Type 2 diabetes guidelines 2009. Available from: http://www.nhmrc.gov.au/publications/synopses/di16to19syn.htm [accessed April 2011].

        • Colagiuri S.
        • Dickinson S.
        • Girgis S.
        • Colagiuri R.
        National evidence based guideline for blood glucose control in type 2 diabetes.
        Diabetes Australia and the NHMRC, Canberra2009
        • Chadban S.
        • Howell M.
        • Twigg S.
        • Thomas M.
        • Jerum G.
        • Alan A.
        • et al.
        National evidence based guideline for diagnosis, prevention and management of chronic kidney disease in type 2 diabetes.
        Diabetes Australia and the NHMRC, Canberra2009
      4. Diabetes management in general practice (17th edition) 2011/12. Available from: http://www.racgp.org.au/guidelines/diabetes [accessed October 2011].

        • Krass R.
        • Hebing B.
        • Mitchell J.
        • Hughes G.
        • Peterson Y.J.C.
        • Song K.
        • et al.
        Diabetes management in an Australian primary care population.
        J Clin Pharm Ther. 2011; 36https://doi.org/10.1111/j.1365-2710.2010.01221.x
        • Green J.
        • Feinglos M.
        Are sulfonylureas passé?.
        Curr Diabetes Rep. 2006; 6: 373-377
        • Dybdahl T.
        • Andersen M.
        • Søndergaard J.
        • Kragstrup J.
        • Kristiansen I.S.
        Does the early adopter of drugs exist? A population-based study of general practitioners’ prescribing of new drugs.
        Eur J Clin Pharmacol. 2004; 60: 667-672
        • Dimmitt S.B.
        • Stampfer H.G.
        Low drug doses may improve outcomes in chronic disease.
        Med J Aust. 2009; 191: 511-513
        • Scullard P.
        • Abdelhamid A.
        • Steel N.
        • Qureshi N.
        Does the evidence referenced in NICE guidelines reflect a primary care population?.
        Br J Gen Pract. 2011; 61: e112-e117
        • Del Prato S.
        • Felton A.M.
        • Munro N.
        • Nesto R.
        • Zimmet P.
        • Zinman B.
        Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal.
        Int J Clin Pract. 2005; 59: 1345-1355
        • Khan A.
        • Hussain R.
        • Plummer D.
        • Minichiello V.
        Too many surveys! Eliciting the views of general practitioners for not participating in postal surveys.
        Aust J Prim Health. 2004; 10: 76-81
        • Schattner P.L.
        • Coman G.J.
        The stress of metropolitan general practice.
        Med J Aust. 1998; 169: 133-137
        • AMWAC
        The general practice workforce in Australia: supply and requirements to 2013.
        Committee AMWA, Sydney2005