Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg

Introduction

Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians’ and patients’ adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients’ characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented.

Study population

The exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068).

Methods

Seven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model.

Results

In 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (−8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (OR_male: 0.87 [95%CI, 0.83−0.92]), the nationality (OR_NonEU: 0.64 [0.52−0.78]), the type of antidiabetic treatment (OR_oral: 1.48 [1.35−1.63], OR_mixed: 1.35 [1.20−1.52]) and the type of treating physician (OR_G-ID: 0.47 [0.42−0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria).

Conclusion

A large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients.

A collaborative expert literature review of pain education, assessment and management

Pain assessment and management in older adults requires a special emphasis on the needs of this population, which is often not considered within general education. The purpose of this study was twofold: to determine the availability of education on pain in older adults around the world, and to present a review and synthesis of published guidelines and key papers on pain assessment and management in older adults. Following on from this study we intend to make recommendations on what work needs to be carried out in future to inform the development of a curriculum or curriculum content specifically dedicated to pain management for older adults. A discussion forum was set up through the Pain in Older Adults Special Interest Group of the International Association for the Study of Pain (IASP) at the end of 2009. This forum was initiated to determine the current level and availability of education available around the world for health professionals on pain in older adults. A number of IASP members from countries around the world participated in the discussion and identified educational courses on pain in older adults from their member country. Following on from this discussion, a number of leading experts agreed to collate guidelines and key papers and conduct a critical review using Appraisal of Guidelines Research and Evaluation (AGREE) criteria. A total of 14 guideline documents on pain assessment and management were reviewed by the group. The papers were reviewed and graded and then agreed between reviewers. From the guideline review, some recommendations can be made, but primarily, the key recommendation from this work was to develop collaboration and a review of key evidence on which future research may be developed so an educational focus may be highlighted. This article presents a summary of those documents along with recommendations for improved and consistent education informed by the guidelines currently developed, and consistent evidence-based assessment and management of chronic pain in older adults.