Attitudes of Italian physicians towards intensive metabolic control in Type 2 diabetes

Aims: To investigate attitudes and expectations of Italian physicians relative to intensive metabolic control in Type 2 diabetes (T2DM) and to compare them with the recent results of the UK Prospective Diabetes Study (UKPDS). Methods: Before the results of the UKPDS were published, a postal questionnaire was sent to 284 diabetologists practising in 237 outpatient diabetes clinics and 107 general practitioners (GPs) to explore their attitudes toward a tight metabolic control and target fasting blood glucose (FBG) level used. We also investigated clinicians' preferences for an aggressive policy in specific patient subgroups and their expectations about the impact of a strict metabolic control on some of the major end-points included in the UKPDS study. Results: The questionnaire was filled in by 199 diabetologists and 94 GPs (response rate=75%). Although 54% of the respondents declared to seek a strict metabolic control, only 15% of them used target FBG levels ≤110 mg/dl, while 38% pursued values > 130 mg/dl. GPs declared significantly less often than diabetologists to adopt an aggressive policy (35% vs 65%, p=0.001), and chose more often a target for FBG >130 mg/dl (44% vs 36%, p=0.02). Only 62% of doctors favouring a strict metabolic control for the average T2DM patient would recommend it for women and 36% for subjects with low educational level. Diabetologists were significantly more likely than GPs to pursue an aggressive policy in obese subjects (70% vs 61%, p=0.03), women (55% vs 18%, p=0.001) and patients with other cardiovascular risk factors (92% vs 81%, p=0.02). The vast majority of respondents did expect a positive impact of a tight metabolic control on micro- and macrovascular complications and on overall mortality. Conclusions: Italian doctors have extremely heterogeneous attitudes and too optimistic expectations relative to intensive metabolic control in T2DM patients. To facilitate the adoption of UKPDS findings, clear guidelines are needed, providing specific recommendations about subgroups of patients showing a higher risk of complications as well as of inappropriate care.