Adherence to ADA Clinical Guidelines in Type 2 Diabetes Management in Public Health Clinics in Palestine.

Background: The prevalence of type 2 diabetes is a significant global public health concern. Adherence to established guidelines is essential for effective management of this metabolic disease.

Objective: This study aimed to evaluate the current practices of physicians in Palestine regarding their adherence to ADA guidelines for type 2 diabetes management.

Methods: A retrospective, cross-sectional, multicenter study was conducted by reviewing patients' medical records. This study included 362 patients aged ≥ 18 years diagnosed with type 2 diabetes for at least one year and receiving treatment at multiple outpatient clinics in Palestine. Adherence to ADA guidelines was assessed by selecting an appropriate antidiabetic agent based on patient confounding factors and comorbidities, frequency of diabetes monitoring, screening, glycemic control, and optimization of hypertension and dyslipidemia medication.

Results: Half of the participants were female. 53% of the participants did not achieve their A1c target goal. Adherence to ADA guidelines for selecting the preferred antidiabetic medication was only 32.22%. Very low adherence to prescribing GLP1 agonists (0.5%) and SGLT2 inhibitors (7%) when indicated. Biguanides were the most prescribed medications (83.1%), followed by sulfonylurea (35.1%), and insulin (28.2%). Only 43% and 66% of the patients were on appropriate lipid and hypertension medications, respectively, as recommended by ADA guidelines. Foot assessment and eye examinations were performed in only 27% and 55% of the patients, respectively. Age, atherosclerotic cardiovascular disease, and sulfonylurea use were significantly associated with lower glycemic control.

Conclusion: This study demonstrated that Adherence to ADA guidelines for diabetes management is suboptimal in selecting appropriate antidiabetic medication based on patient confounding factors, potentially contributing to the high prevalence of complications and comorbidities observed in patients with diabetes in Palestine. Medical associations and health institutions must adopt programs to increase professional education and awareness of the current guidelines to improve outcomes.