Introduction

Considering the increase in the number of patients with diabetes, the quality of diabetes care provided by general practitioners (GP) is critical for preventing complications. We performed a nationwide survey to determine whether the diabetic management provided to patients with type 2 diabetes mellitus (T2DM) by Japanese practitioners is appropriate.

Methods

We randomly selected 463 clinics throughout Japan; 8070 patients with T2DM (6525 and 1545 under the care of GP and specialists [SP], respectively) were enrolled. We obtained information on hemoglobin A1c (HbA1c) levels, age, height, body weight, diabetes type and treatment modality, blood pressure (BP), and hypertension or dyslipidemia from each patient. Additionally, we surveyed the collaborations among physicians.

Results

The median HbA1c level of patients treated by GP was lower than that of patients treated by SP (6.8 [6.2–7.3], median [interquartile range] vs. 6.9 [6.5–7.5], p < 0.0001). The percentage of patients receiving insulin therapy was also higher (23.8%) among patients treated by SP than among those treated by GP (8.6%). Patients not receiving insulin therapy showed lower median HbA1c levels than those receiving insulin therapy, irrespective of the care provider. The mean body mass index of patients with HbA1c levels < 6.9% or > 9.0% cared for by SP was lower than that of those cared for by GP. The rate of target BP (< 140/90 mmHg) achievement was 73.2% and 73.3% among patients with T2DM and hypertension cared for by GP and SP, respectively. Furthermore, 88.2% of GP reported that consulting with SP was easy.

Conclusion

The present study clearly demonstrated that many patients with T2DM are appropriately cared for by general practitioners instead of diabetes specialists in Japan, although the number of diabetes specialists is insufficient to cover all patients with diabetes.

中文翻译：

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日本从业人员对2型糖尿病实际干预的全国调查（NSAID研究1）：血糖，体重和血压管理。

介绍

考虑到糖尿病患者人数的增加，全科医生（GP）提供的糖尿病护理质量对于预防并发症至关重要。我们进行了一项全国性调查，以确定日本从业人员为2型糖尿病（T2DM）患者提供的糖尿病管理是否适当。

方法

我们在日本随机选择了463家诊所；入组8070例T2DM患者（分别由GP和专科医生[SP]照管，分别为6525和1545）。我们从每位患者获得了有关血红蛋白A1c（HbA1c）水平，年龄，身高，体重，糖尿病类型和治疗方式，血压（BP）以及高血压或血脂异常的信息。此外，我们调查了医生之间的合作。

结果

GP治疗的患者的中位HbA1c水平低于SP治疗的患者（6.8 [6.2-7.3]，中位[四分位间距]与6.9 [6.5-7.5]，p  <0.0001）。在接受SP治疗的患者中，接受胰岛素治疗的患者比例也更高（23.8％），相比于接受GP治疗的患者（8.6％）。无论接受何种护理，未接受胰岛素治疗的患者的中位HbA1c水平均低于接受胰岛素治疗的患者。SP照护的HbA1c水平<6.9％或> 9.0％的患者的平均体重指数低于GP照护的患者。在GP和SP照料下的T2DM和高血压患者中，目标BP（<140/90 mmHg）达成率分别为73.2％和73.3％。此外，有88.2％的GP表示与SP进行咨询很容易。

结论

本研究清楚地表明，尽管日本的糖尿病专科医生人数不足以覆盖所有糖尿病患者，但在日本，许多T2DM患者均由全科医生而非糖尿病专科医师适当护理。