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Meeting American Diabetes Association guidelines in endocrinologist practice
C D Miller1, L S Phillips, M K Tate
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Diabetes Care
|June 17, 2000
Summary
Routine endocrinology practice can meet American Diabetes Association (ADA) guidelines for diabetes management. Complex treatment regimens achieve glycemic control comparable to clinical trials, even with patients facing multiple health issues.
Area of Science:
- Endocrinology
- Diabetes Management
- Clinical Practice Guidelines
Background:
- American Diabetes Association (ADA) guidelines provide standards for diabetes care.
- Routine endocrinology practice involves managing patients with complex health profiles.
Purpose of the Study:
- To assess if ADA guidelines are achievable in a standard endocrinology practice.
- To evaluate process measures and metabolic outcomes in diabetic patients.
Main Methods:
- Retrospective chart review of patients with type 1 and type 2 diabetes.
- Analysis of glycemic control, process measures (eye exams, lipid profiles, albuminuria screening), and metabolic outcomes over one year.
- Inclusion criteria: > or = 1 year follow-up and two or more visits.
Main Results:
- Type 2 diabetes patients (n=121) had high rates of comorbidities (hypertension, hyperlipidemia) and complications (neuropathy, retinopathy).
- Despite complex regimens (oral agents, insulin), mean HbA1c was 6.9% for type 2 and 7.1% for type 1 diabetes.
- High adherence to recommended screenings: 74% eye exams, 70% lipid profiles, 55% urine albumin screening.
Conclusions:
- Endocrinologists can meet ADA guidelines in routine practice.
- Complex treatment strategies are effective in achieving glycemic control comparable to major trials.
- Multifaceted patient problems do not preclude guideline adherence.
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