Multifaceted Determinants for Achieving Glycemic Control the International Diabetes Management Practice Study (IDMPS)

OBJECTIVE - the International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.RESEARCH DESIGN and METHODS - Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 1.7 countries in Eastern Europe (n = 3,519), Asia (n = 5,888), Latin America (n = 2,116), and Africa (n = 276).RESULTS - Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. in those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n = 696) and 3.6% of type 2 diabetic (n = 3,896) patients attained all three recommended targets (blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). in type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment With few oral glucose-lowering drugs (Asia 0,64, Latin America 0.76, and Eastern Europe 0,62) were predictors, Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in Patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe.CONCLUSIONS - in developing countries, factors pertinent to Patients, doctors, and health care systems all impact on glycemic control.Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R ChinaNatl Univ La Plata, Sch Med,Ctr Expt & Appl Endocrinol, Collaborating Ctr Diabet,Natl Sci & Tech Res Coun, WHO,Pan Amer Hlth Org, La Plata, Buenos Aires, ArgentinaKorea Univ, Guro Hosp, Dept Internal Med, Seoul, South KoreaDept Intercontinental Med Affairs, Paris, FranceUniversidade Federal de São Paulo, Dept Prevent Med, São Paulo, BrazilIuliu Hatieganu Univ Med, Diabet Ctr & Clin, Cluj Napoca, RomaniaIstanbul Univ, Cerrahpasa Med Fac, Dept Internal Med, Istanbul, TurkeyDr A Ramachandrans Diabet Hosp, India Diabet Res Fdn, Madras, Tamil Nadu, IndiaJaveriana Univ, Endocrinol Unit, Bogota, ColombiaUniversidade Federal de São Paulo, Dept Prevent Med, São Paulo, BrazilWeb of Scienc