Savona-Ventura Charles, Vassallo Josanne
Department of Obstetrics and Gynaecology, University of Malta, Tal-Qroqq, Msida, Malta.
Department of Medicine, University of Malta, Tal-Qroqq, Msida, Malta.
Diabetes Ther. 2019 Oct;10(5):1909-1920. doi: 10.1007/s13300-019-00675-2. Epub 2019 Jul 31.
This study aimed to assess the adherence to guidelines by practitioners working in the Mediterranean region and to identify the reasons for non-compliance.
A opportunistic self-administered questionnaire was circulated among members of the Mediterranean Group for the Study of Diabetes (MGSD) and regional diabetic associations. The study was limited to the Mediterranean region; 2841 medical practitioners participated in the study. Intervention involved a self-administered questionnaire enabling demographic and personal details to be correlated to relevant information related to practice and continuing health professional education (CHPE) attitudes, perceptions related to diabetes and healthcare systems in the community, and physicians' attitudes to healthcare practices and target goals relevant to type 2 diabetes mellitus (T2DM). The main outcome measure was adherence to evidence-based guidelines.
While the majority of respondents (69.9%) reported being confident in managing these patients, and 79.2% reported being aware of the availability of local guidelines; only a fifth opted to manage patients by strictly targeting an HbA1c value below 6.5%, while 3.3% were happy to maintain an HbA1c value of up to 8.0%. These goals appeared to be tempered by fear of eliciting hypoglycaemia in the belief that patients and their families do not have the skills to manage the complication. Endocrinologists/internists preferred more rigid control.
It is clear that the promulgation of evidence-based guidelines cannot assume automatic adoption in clinical practice since adoption is tempered by on-the-ground practice circumstances that make the practitioner reluctant to fully endorse and adopt the targets defined by the guidelines. The evidence-based guidelines need to be modified for local or regional circumstances.
This study and the Rapid Service Fee were supported by a financial grant from the Mediterranean Group for the Study of Diabetes which is supported by an unrestricted educational grant from Servier.
本研究旨在评估地中海地区从业者对指南的遵循情况，并确定不遵守的原因。
向地中海糖尿病研究小组（MGSD）成员和地区糖尿病协会发放了一份机会性自填问卷。该研究仅限于地中海地区；2841名医学从业者参与了研究。干预措施包括一份自填问卷，该问卷能够将人口统计学和个人详细信息与实践相关信息以及持续健康专业教育（CHPE）态度、与社区糖尿病和医疗保健系统相关的认知，以及医生对与2型糖尿病（T2DM）相关的医疗保健实践和目标的态度相关联。主要结局指标是对循证指南的遵循情况。
虽然大多数受访者（69.9%）表示有信心管理这些患者，79.2%表示知晓当地指南的存在；但只有五分之一的人选择通过严格将糖化血红蛋白（HbA1c）值控制在6.5%以下来管理患者，而3.3%的人愿意将HbA1c值维持在高达8.0%。由于担心引发低血糖，且认为患者及其家属没有处理并发症的技能，这些目标似乎受到了影响。内分泌科医生/内科医生倾向于更严格的控制。
显然，循证指南的颁布不能假定在临床实践中会自动被采用，因为实际的实践情况会使从业者不愿完全认可和采用指南所定义的目标，从而影响了指南的采用。循证指南需要根据当地或地区情况进行修改。
本研究及快速服务费由地中海糖尿病研究小组的一笔财政拨款支持，该小组由施维雅公司的无限制教育拨款资助。
