PMID- 31023374 OWN - NLM STAT- MEDLINE DCOM- 20190820 LR - 20221207 IS - 1472-6823 (Electronic) IS - 1472-6823 (Linking) VI - 19 IP - 1 DP - 2019 Apr 25 TI - A Greek registry of current type 2 diabetes management, aiming to determine core clinical approaches, patterns and strategies. PG - 39 LID - 10.1186/s12902-019-0364-5 [doi] LID - 39 AB - BACKGROUND: To analyze data in terms of the glycaemic control and therapeutic regimens used for Type-2 Diabetes Mellitus (T2DM) management in Greece, identify factors that influence clinical decisions and determine the level of compliance of T2DM management with the latest international and local guidelines. METHODS: 'AGREEMENT' was a national-multicenter, non-interventional, cross-sectional disease registry. A total of 1191 adult T2DM patients were enrolled consecutively from 59 sites of the National Health System (NHS) or University Hospitals, representing the majority of Diabetes centers or Diabetes outpatient clinics in Greece with a broad geographic distribution. Patients were stratified by gender and analysis was done according to 3 treatment strategies: A (lifestyle changes or use of one oral antidiabetic agent), B (up to 3 antidiabetic agents including injectables but not insulin) and C (any regimens with insulin). RESULTS: Mean (+/-SD) HbA1c % of the total population was 7.1 (+/-1.2) while mean (+/-SD) FPG (mg/dl) was measured at 136 (+/-42). The proportion of patients who achieved HbA1c < 7% was 53% and ranged from 74.2% for group A, to 60.6% for group B and 35.5% for group C. Median age of the studied population was 65.0 year old (Interquartile Range-IQR 14.0) with an equal distribution of genders between groups. Patients on insulin therapy (treatment strategy C) were older (median age: 67 years vs 63 or 65 for A and B, respectively) with longer diabetes duration (mean duration: 15.3 years vs 5.2 and 10.1 for A and B, respectively). Patients who received insulin presented poor compliance. There was a consensus for a series of decision criteria and factors that potentially influence clinical decisions, used by physicians for selection of the therapeutic strategy among the three groups. Compliance with international and Greek guidelines received a high score among groups A, B and C. No significant differences were presented as per sites' geographic areas, NHS or University centers and physicians' specialty (endocrinologists, diabetologists and internists). CONCLUSIONS: The presented findings suggest the need for improvement of the glycaemic control rate, especially among insulin treated patients as this group seems to achieve low glycaemic control, by setting appropriate HbA1c targets along with timely and individualised intensification of treatment as well as post-therapy evaluation of the compliance with the proposed treatment. FAU - Liatis, Stavros AU - Liatis S AD - First Department of Propaedeutic Medicine, Diabetes Center, Athens University Medical School, Laiko Hospital, Ag Thoma 17, 11527, Athens, Greece. sliatis@med.uoa.gr. FAU - Iraklianou, Styliani AU - Iraklianou S AD - Diabetes Center, Tzanio General Hospital, Piraeus, Greece. FAU - Kazakos, Kyriakos AU - Kazakos K AD - Faculty of nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece. FAU - Mastorakos, George AU - Mastorakos G AD - Department of Endocrinology, Metabolism and Diabetes, Aretaieio Hospital, School of Medicine, University of Athens, Athens, Greece. FAU - Milios, Kostas AU - Milios K AD - Medical Department, Sanofi, Athens, Greece. FAU - Mouslech, Zadalla AU - Mouslech Z AD - 1st Medical Propaedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. FAU - Noutsou, Marina AU - Noutsou M AD - Diabetes Center, General Hospital of Athens "Hippokration", Athens, Greece. FAU - Pagkalos, Emmanouil AU - Pagkalos E AD - Clinic "Thermi," Thessaloniki, Thessaloniki, Greece. FAU - Sampanis, Christos AU - Sampanis C AD - Diabetes Centre, Second Propaedeutic Department of Internal Medicine, General Hospital of Thessaloniki - "Hippokration", Thessaloniki, Greece. CN - AGREEMENT Investigators LA - eng PT - Journal Article PT - Multicenter Study DEP - 20190425 PL - England TA - BMC Endocr Disord JT - BMC endocrine disorders JID - 101088676 RN - 0 (Biomarkers) RN - 0 (Blood Glucose) RN - 0 (Glycated Hemoglobin A) RN - 0 (Hypoglycemic Agents) RN - 0 (hemoglobin A1c protein, human) MH - Aged MH - Biomarkers/analysis MH - Blood Glucose/analysis MH - Cross-Sectional Studies MH - Diabetes Mellitus, Type 2/*drug therapy/epidemiology MH - Disease Management MH - Female MH - Follow-Up Studies MH - Glycated Hemoglobin/analysis MH - Greece/epidemiology MH - Humans MH - Hypoglycemic Agents/*therapeutic use MH - Male MH - Middle Aged MH - Patient Selection MH - Practice Guidelines as Topic/*standards MH - Practice Patterns, Physicians'/*standards MH - Prognosis MH - Registries/*statistics & numerical data PMC - PMC6482543 OTO - NOTNLM OT - Clinical decisions OT - Compliance OT - Glycaemic control OT - Guidelines OT - Type-2 diabetes mellitus COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study protocol was approved by all Hospitals' Review Boards and conducted in accordance with Good Pharmacoepidemiology Practices (GCPs) and all applicable regulations. All patients provided written informed consent. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: Dr. Stavros Liatis has received research support and/or consulting honoraria from Astra-Zeneca, Boeringer Ingelheim, MSD, Novartis, Novo Nordisk, Sanofi, Pharmaserve Lilly and ELPEN and is a member of the Editorial Board of BMC Endocrine Disorders. Dr. Styliani Iraklianou has received research support and consulting honoraria from Sanofi. Dr. Kyriakos Kazakos has received research support and/or consulting honoraria from Astra Zeneca, Sanofi Aventis, Novo Nordisk and Lilly. Pr. George Mastorakos declares no conflict of interest. Kostas Milios is an employee of Sanofi working as Field Medical for Greece. Dr. Zadalla Mouslech has received research support and/or consulting honoraria from Sanofi and Lilly. Dr. Marina Noutsou has received research support and/or consulting honoraria from Novo Nordisk, Sanofi Aventis, Lilly, Boehringer Ingelheim, ELPEN and Astra Zeneca. Dr. Emmanouil Pagkalos has received research support and/or consulting honoraria from Astra Zeneca, Bayer, BetaIotaAlphaNuEpsilonChi, Boehringer Ingelheim, ELPEN, Galenica, GSK, Jansen, Lilly, MSD, Novartis, Novo Nordisk, Roche, Sanofi, Takeda and Winmedica. Dr. Christos Sampanis has received research support and /or consulting honoraria from Novo Nordisk, Sanofi and Lilly Co. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. FIR - Zoi, Alexiou IR - Zoi A FIR - Olga, Almanidou-Kougioumtzidi IR - Olga AK FIR - Eleni, Anastasiou IR - Eleni A FIR - Iakovos, Avramidis IR - Iakovos A FIR - Sofoklis, Betaakidis IR - Sofoklis Beta FIR - Alexandra, Bargiota IR - Alexandra B FIR - Christos, Bikas IR - Christos B FIR - Stavros, Bousboulas IR - Stavros B FIR - Dimitrios, Boutel IR - Dimitrios B FIR - Georgios, Chaliotis IR - Georgios C FIR - Alexandra, Chrisoulidou IR - Alexandra C FIR - Triantafyllos, Didangelos IR - Triantafyllos D FIR - George, Dimitriadis IR - George D FIR - Eftihia, Dimou IR - Eftihia D FIR - Petros, Douitsis IR - Petros D FIR - John, Doupis IR - John D FIR - Triada, Exiara IR - Triada E FIR - Maria, Gkioka IR - Maria G FIR - Nikolaos, Gkioulos IR - Nikolaos G FIR - Pinelopi, Grigoropoulou IR - Pinelopi G FIR - Ioannis, Ioannidis IR - Ioannis I FIR - Evridiki, Kirlaki IR - Evridiki K FIR - Kostas, Kitsios IR - Kostas K FIR - Panagiotis, Kokkoris IR - Panagiotis K FIR - Kalliopi, Kotsa IR - Kalliopi K FIR - Maria, Kouroglou IR - Maria K FIR - Leonidas, Lanaras IR - Leonidas L FIR - Konstantinos, Magiannis IR - Konstantinos M FIR - Christos, Manes IR - Christos M FIR - Georgios, Marathonitis IR - Georgios M FIR - Andreas, Melidonis IR - Andreas M FIR - Ilias, Migdalis IR - Ilias M FIR - Asimina, Mitrakou IR - Asimina M FIR - Stefanos, Papantoniou IR - Stefanos P FIR - Dimitrios, Papazoglou IR - Dimitrios P FIR - Georgios, Piaditis IR - Georgios P FIR - Evangelos, Potolidis IR - Evangelos P FIR - Ioannis, Prokovas IR - Ioannis P FIR - Evangelos, Rizos IR - Evangelos R FIR - Maria, Rogkoti IR - Maria R FIR - Alexandra, Romanidou IR - Alexandra R FIR - Christos, Sampanis IR - Christos S FIR - Aimilios, Satsoglou IR - Aimilios S FIR - Dimitrios, Simelidis IR - Dimitrios S FIR - El Hasban, Taisir IR - El Hasban T FIR - Nikolaos, Tentolouris IR - Nikolaos T FIR - Anastasia, Thanopoulou IR - Anastasia T FIR - Apostolos, Tolis IR - Apostolos T FIR - Iraklis, Tsanikidis IR - Iraklis T FIR - Apostolos, Tsapas IR - Apostolos T FIR - Panagiotis, Tsapogas IR - Panagiotis T FIR - Agathoklis, Tsatsoulis IR - Agathoklis T FIR - Stefanos, Tsotoulidis IR - Stefanos T FIR - Glykeria, Tzatzagou IR - Glykeria T FIR - Panagiotis, Vasiliadis IR - Panagiotis V FIR - Charalampos, Vasilopoulos IR - Charalampos V FIR - Anestis, Vlachogiannis IR - Anestis V FIR - Andromachi, Vryonidou IR - Andromachi V FIR - Apostolos, Xilomenos IR - Apostolos X EDAT- 2019/04/27 06:00 MHDA- 2019/08/21 06:00 PMCR- 2019/04/25 CRDT- 2019/04/27 06:00 PHST- 2018/02/15 00:00 [received] PHST- 2019/04/04 00:00 [accepted] PHST- 2019/04/27 06:00 [entrez] PHST- 2019/04/27 06:00 [pubmed] PHST- 2019/08/21 06:00 [medline] PHST- 2019/04/25 00:00 [pmc-release] AID - 10.1186/s12902-019-0364-5 [pii] AID - 364 [pii] AID - 10.1186/s12902-019-0364-5 [doi] PST - epublish SO - BMC Endocr Disord. 2019 Apr 25;19(1):39. doi: 10.1186/s12902-019-0364-5.