Adherence to HbA1c testing guidelines in type 2 diabetes patients: A mixed-methods retrospective cross-sectional study in Bahrain’s primary healthcare centers

A BSTRACT Introduction: Type 2 diabetes mellitus (T2DM) accounts for over 90% of diabetes cases worldwide. Glycated hemoglobin (HbA1c) testing helps manage it effectively. Despite national guidelines in Bahrain, physician adherence varies due to knowledge, resource, and system barriers. This study assesses adherence and influencing factors in Bahrain’s primary healthcare centers. Methods: A mixed-method retrospective cross-sectional study was conducted at eight primary healthcare centers (PHCs) in Bahrain, including 352 T2DM patient’s electronic records from 2017 to 2020. Inclusion criteria comprised adult patients (≥18 years) with a confirmed T2DM diagnosis of at least one year’s duration and at least one PHC visit during 2020. Data regarding demographics, HbA1c requests, and non-communicable disease clinic attendance were collected. Additionally, 375 PHC physicians completed structured surveys assessing their adherence to guidelines and barriers they faced. SPSS was used for descriptive, comparative, and multivariate statistical analyses. Results: Among 352 T2DM patients (57.4% female), significant testing gaps were identified: 13.4% had no test requests, and 18.8% had no completed tests despite guideline recommendations. Non-communicable disease clinic attendance significantly correlated with higher HbA1c test requests and completions ( P < 0.001). Key barriers to testing included resource limitations, time constraints, and patient non-compliance. Conclusion: This study highlighted the gaps between diabetes care guidelines and practice in Bahrain’s PHCs, and also emphasized the physician support, patient attendance, and targeted interventions for improvement.