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Title: Multifaceted Determinants for Achieving Glycemic Control the International Diabetes Management Practice Study (IDMPS)
Authors: Chan, Juliana C. N.
Gagliardino, Juan Jose
Baik, Sei Hyun
Chantelot, Jean-Marc
Ferreira, Sandra Roberta Gouvea [UNIFESP]
Hancu, Nicolae
Ilkova, Hasan
Ramachandran, Ambady
Aschner, Pablo
IDMPS Investigators
Chinese Univ Hong Kong
Natl Univ La Plata
Korea Univ
Dept Intercontinental Med Affairs
Universidade Federal de São Paulo (UNIFESP)
Iuliu Hatieganu Univ Med
Istanbul Univ
Dr A Ramachandrans Diabet Hosp
Javeriana Univ
Issue Date: 1-Feb-2009
Publisher: Amer Diabetes Assoc
Citation: Diabetes Care. Alexandria: Amer Diabetes Assoc, v. 32, n. 2, p. 227-233, 2009.
Abstract: 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.
ISSN: 0149-5992
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