Treatment of diabetes mellitus - physicians' adherence to clinical guidelines in Norway

OBJECTIVE: To assess general practitioners' current adherence to the Norwegian clinical guidelines for the treatment of diabetes mellitus. DESIGN: Descriptive, retrospective registration of information from patient records of one year; 7 November 1993 to 7 November 1994. In addition, mailed questionnaire to examine the representativeness of the participating doctors. SETTING: General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants. PARTICIPANTS: In one year 1119 patients were registered with the diagnosis of diabetes mellitus in the records of 56 general practitioners. The patients were 53% women and 47% men; 51% were 70 years or older. MAIN OUTCOME MEASURES: Levels of HbA1c and blood pressure in accordance with the recommendations of the Norwegian clinical guidelines for diabetes mellitus. Fractions of patients with a measured HbA1c, blood pressure, and serum cholesterol in one year. RESULTS: At least one HbA1c was recorded in 77% of the diabetic patients during the specified year. In patients under 70 years of age, 56% had HbA1c above the recommended treatment level of 7.5%. In patients 70 years of age or older, 36% were above the recommended limit of 8.5%. At least one blood pressure was recorded in 79% of the patients during the specified year. In patients under 70 years of age, 53% had a systolic blood pressure above the recommendations of 140 mmHg, and 22% had a diastolic blood pressure above the recommendations of 90 mmHg. Serum cholesterol was not recorded during the specified year in 75% of the patients. CONCLUSION: There are still major discrepancies between current practice and the intentions laid down in the Norwegian clinical guidelines. A discussion of alternative methods for implementation and evaluation of the efficacy of clinical guidelines is needed.