Attainment of American Diabetes Association clinical practice recommendations in 722 Thai type 2 diabetes patients.

BACKGROUND: Each year the American Diabetes Association (ADA) publishes the update clinical practice recommendation. However, the achievement of these practice recommendations remained suboptimal in several studies. The purpose of this study is to determine the degree diabetes patients achieved optimal clinical practice recommendations and to determine factors associated with reduced attainment of these recommendations in T2DM patient. MATERIAL AND
METHOD: We conducted retrospective review medical records of Thai type 2 diabetes patients who were followed-up at out-patient department of internal medicine department, Siriraj hospital, Thailand, during January to December 2006.
RESULTS: Of 722 diabetes patients who were recruited, 64.5% and 60% had received HbA1c and plasma lipid profiles measurements, respectively, whereas blood pressure measurement was done in all patients. Forty-nine percent achieved the target HbA1c of less than 7%, 64% achieved LDL-C and HDL-C targets and 58% achieved the triglycerides target, whereas only 31% of the patients achieved the BP target recommendation. Fifty-two percent of patients achieved at least 3 items according to ADA practice recommendation and 47.8% achieved only 0-2 items of clinical recommendation. Category of health care provider and elderly patients were independent factors for attainment of clinical practice recommendations. Moreover, patients who were diagnosed with diabetes for longer than 10 years and who used insulin treatment were independent factors for achieving good glycemic control.
CONCLUSION: These data demonstrated a substantial proportion of diabetes patients did not achieve ADA clinical practice recommendations. This apparent gap was depended on categories of health care provider and patients' age. The novel and more effective strategies targeted these groups are needed to improve achievement of these recommendations.