Clinical Management of the NIDDM Patient: Impact of the American Diabetes Association Practice Guidelines, 1985–1993

OBJECTIVE: To assess the impact of the American Diabetes Association's (ADA's) standards of care for patients with non-insulin-dependent diabetes mellitus (NIDDM) on practice patterns among university-based endocrine physicians and fellows. RESEARCH DESIGN AND METHODS: This study represents a retrospective chart-based review of 790 patients with NIDDM conducted by endocrine fellows in training at 42 academic institutions. By using an ADA guidelines-based questionnaire, patient management and adherence to the guidelines were assessed by reviewing charts dating > or = 3 years before, the year of, and 3 years after the guidelines' publication. All calculations were performed using the McNemar test, and all P values are two-sided. RESULTS: The ADA standards of care have not had the significant impact in the clinical training setting that was anticipated. Deficiencies were noted in all aspects of the diabetic patient encounter and did not improve significantly following publication of the guidelines, except in the areas of foot care, eye examination, and lipid screening. Major deficiencies exist in areas of quality assurance and chart documentation, and these did not improve over time. CONCLUSIONS: New strategies must be devised to increase awareness and implementation of these guidelines, both to enhance patient care and to improve the training of future diabetes caregivers.