Therapeutic management of orally treated type 2 diabetic patients, by French general practitioners in 2010: the DIAttitude Study

Abstract Aim To describe the behaviour of French general practitioners (GP) regarding intensification of hypoglycaemic agents in orally treated type 2 diabetic (T2D) patients, according to their HbA 1c level. Methods General practitioners were recruited from a panel of office-based general practitioners. T2D patients who had been orally treated for at least 6 months were included in the study; their characteristics were recorded, and their HbA 1c values and hypoglycaemic treatments over the previous 24 months extracted from electronic records The major reasons for intensification (or no intensification) of hypoglycaemic agents were recorded at the inclusion visit. Results A total of 236 general practitioners recruited 2109 T2D patients: 1732 had at least one HbA 1c value recorded in the previous 6 months, and 52%, 33% and 14% had been treated, with oral hypoglycaemic agents in monotherapy, bitherapy or tri-or quadritherapy, respectively. Of these patients, 702 (41%) remained uncontrolled (47%, 39% and 20% respectively) and according to the current French guidelines needed treatment intensification. Only 46 (7%) had their treatment intensified at inclusion. Of those without intensified treatment, 60% were treated with monotherapy; the main reason given by the general practitioners for not intensifying treatment was a satisfactory HbA 1c level (53%), although 32% had an HbA 1c >7%. Other reasons were: lifestyle advice had greater priority (20%); decision was postponed until the next visit (11%); HbA 1c had decreased since last visit (7%; not confirmed by available data in 58% of cases); a medical priority other than diabetes (6%) and other reasons related to the patient (3%). Conclusion For T2D patients managed by French general practitioners, guidelines are not consistently followed: HbA 1c should be monitored more frequently and treatment adjusted according to HbA 1c levels.