The role of physicians' knowledge and attitudes in effective diabetes management.

We examined the role of physicians' knowledge and attitudes in effective diabetes management among internal medicine house staff. We examined the extent to which (1) knowledge of common diabetes management strategies and (2) beliefs about the efficacy of, and intentions to engage in, such strategies predict success in their management of patients with diabetes. Successful managers are those house staff whose ambulatory diabetes patients' fasting blood sugar levels were lower than the clinic median. Knowledge was assessed with a written case simulation of an obese noninsulin-dependent woman; beliefs and intentions were surveyed through a self-administered questionnaire. The data suggest that knowledge was unable to discriminate physicians who are relatively successful in controlling their patient's blood sugar levels from those who are less successful. However using intentions related to initial and follow-up management strategies and beliefs about the benefits of achieving euglycemia, there was discrimination between the two physician groups (P less than 0.001). These findings suggest that beliefs are important in understanding why some physicians are successful managers. Further, if beliefs are mutable, continuing medical education courses could be more effective by fostering critical beliefs rather than depending solely upon the transfer of new medical information.