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PDB147 Why Physicians Do not folloW aacE/acE guiDElinEs in trEating qualifiED PatiEnts With t2DM: a survEy stuDy in thE unitED statEs Qiu Y.1, Li Q.1, Tang J.2, Fan C.P.S.2, Li Z.2, Apecechea de Scheffer M.3, Hegar R.3, Shankar R.1, Engel S.S.1 1Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA, 2AscelpiusAnalytics Ltd., Hong Kong, Hong Kong, 3Kantar Health Germany, Munich, Germany Objectives: To assess factors affecting physicians’ decision on why they did not initiate dual therapy to untreated Type 2 Diabetes Mellitus (T2DM) patients with A1C 7.6–9% per AACE/ACE recommendation. MethOds: Primary care physicians (PCPs) and specialists in the US were asked to provide medical chart reviews for 4 patients who were diagnosed with A1C 7.6-9% and initiated with metformin monotherapy. Physicians rated 22 reasons on a 5-point Likert scale (1-most irrelevant; 5-most relevant) on how relevant each reason was for them in treating a specific patient. Top 5 reasons ( ≥ 50% of physicians rating the reason as 4 or 5) were identified. Association of each reason on physician specialty or age was conducted using mixed-effect model controlling for physician and patient characteristics. Results: 1,235 PCPs and 290 specialists participated the study and provided reviews for 5,995 patients (3,009 young and 2,986 elderly). Four relevant reasons were related to physicians attitudes and beliefs toward metformin monotherapy and dual therapy: R1-“Metformin monotherapy is sufficient to improve glycemic control” (mean[sd]: 3.66[1.1]); R2 “Monotherapy is easier to handle than dual therapy” (3.53[1.2]); R3“I believe that monotherapy and changes in lifestyle (e.g. physical activity and dietary change) are enough for hyperglycemia control” (3.47[1.1]); and R4“I recommend monotherapy before considering dual therapy” (3.75[1.1]). One relevant reason was related to physicians’ perception of patients’ glycemic level: R5 -“Patient has mild hyperglycemia” ” (3.27[1.1]). PCPs rated the four reasons more relevant than specialists (estimate,[95% CI]) (R1: 0.18,[0.05,0.30]; R2: 0.37,[0.24,0.50]; R3: 0.33,[0.20,0.46]; R4: 0.36,[0.23,0.49]. All p< 0.01). Lowering age was also more relevant in the four reasons (R1: -0.04,[-0.06,-0.02]; R2: -0.03,[-0.05,-0.02]; R3: -0.02,[-0.03,0.00], R4: -0.06,[0.07,-0.04]. All p< 0.02). cOnclusiOns: Guideline non-concordance is related to physicians’ attitudes and beliefs toward the therapies and perception of A1C above 8% as “mild”. The findings have implications for improving T2DM treatment quality. |
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