The gap between guidelines and practice in the treatment of type 2 diabetes. A nationwide survey in Norway

AIMS: In a nationwide sample of patients with type 2 diabetes we assessed the prevalence of complications and compliance with current guidelines.

METHODS: We recruited a randomly selected sample of 534 men and 441 women aged 18-75 years with type 2 diabetes. A single visit review of medical records, interview, physical examination and laboratory tests was collected.

RESULTS: The WHO criteria for the metabolic syndrome were met by 79% [74%, 84%]. Thirty percent [28%, 33%] had a history of cardiovascular disease, 13% [11%, 16%] had microalbuminuria, 15% [13%, 18%] had retinopathy, and 23% [21%, 26%] had peripheral neuropathy assessed by a monofilament test. Erectile dysfunction was common (43% [38%, 47%]). Two thirds met the national treatment target for glycaemia (HbA1c <7.5%), one-half the blood pressure target (BP <140/85mmHg), and one-third the target for lipids (total/HDL cholesterol <4). However, only 13% reached the combined targets for glucose, blood pressure and cholesterol control.

CONCLUSIONS: The classical microvascular complications of diabetes affected a minority of participants while the metabolic syndrome affected the majority. The gap between guidelines and current clinical practice was substantial given that only one of eight patients reached the combined goals for glycaemia, blood pressure and lipid control.