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 (28.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (OR_male: 0.87 [95%CI, 0.8320.92]), the nationality (OR _NonEU: 0.64 [0.5220.78]), the type of antidiabetic treatment (OR _oral: 1.48 [1.3521.63], OR_mixed: 1.35 [1.202 1.52]) and the type of treating physician (OR_G-ID: 0.47 [0.4220.53]) 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.