Objective: Toexplore how clinical and demographic variables impact on the management ofdiabetes mellitus in general practice.
Design: Astructured vignette survey was conducted in Australia. This included ninevignettes chosen at random from 128 developed around seven clinical variables.Respondents were asked to recommend a change in treatment and make specificrecommendations. A random sample of general practitioners (GPs) were recruited.Two diabetologists involved in the development of national guidelines alsoparticipated.
Results: 125(13.8%) GPs participated. Statistical analyses were used to generate outcomemeasures. GPs recommended a change in treatment for most (81.1%) cases; wereless likely to prescribe a statin (68.5% GPs vs.76.3% diabetologists), lesslikely to treat hypertension (66.7% vs.89%) and less likely to refer forlifestyle modification (82.3% vs. 96.5%). Significant disagreement occurredaround prescribing or changing oral hypoglycaemics. No GP characteristicsshowed significant impact. The proportion of GPs who agreed withdiabetiologists on dose and choice of drugs was 35.7% for statins, 49.6%forantihypertensives and 39.6% for oral hypoglycaemics.
Conclusions:There were significant differences between diabetologists and GPs on themanagement of diabetes. The survey suggestssignificant under-dosing by GPs.These findings warrant further investigation.