Poor guideline adherence in type 1 diabetes education in real-world clinical practice: Evidence from a multicentre, national survey

Objective: To examine how physicians implement guidelines to deliver insulin dosing education for type 1 diabetes patients in real-world settings. Methods: A nationally representative sample of endocrinologists from top tertiary hospitals in China was obtained by a multistage random sampling method (n = 385). Knowledge, perceptions and practices of insulin dosing were assessed by validated questionnaires. Multivariable logistic regression was used to identify independent determinants of clinical practice and knowledge. Results: Only 20.5% of endocrinologists correctly answered > 75% of the items regarding insulin dosing knowledge. Only 37.7% of endocrinologists reported often teaching insulin-to-carbohydrate ratio and insulin sensitivity factor. Practice behaviours were independently associated with guideline familiarity (OR: 5.92, 95% CI: 3.36-10.41), receiving standardized training (OR: 2.00, 95% CI:1.23-3.25), self-reported lack of time (OR: 0.58, 95% CI:0.34-0.99) and insufficient teaching approaches (OR: 0.57, 95% CI:0.33-0.97) Conclusions: There was a large gap between guidelines and clinical practice in insulin dosing education. Modifiable factors, including self-reported lack of time, unfamiliarity with guidelines, the shortage of medical training and educational tools hinder insulin dosing education. Practice implications: Sufficient medical training and educational tools are important to optimize insulin dosing education. The current care paradigm should also be modified to relieve the burden of physicians. (c) 2021 Elsevier B.V. All rights reserved.