Assessing the influences on therapeutic intensification in type 2 diabetes mellitus according to career stage.

Aim: This study was designed to document the factors influencing therapeutic decisions in the management of diabetes in relation to stage of medical career.

Methods: An anonymous survey was distributed among medical students, resident medical officers (RMOs) and general practitioners (GPs) presenting a hypothetical case of a 58 year old patient with sub-optimally controlled diabetes on metfomin and gliclazide. Participants were then asked for their next step in management and about factors that would influence their decision-making.

Results: GPs (n=72) were most likely to add pioglitazone (33.3%). RMOs (n=42) were more likely to add insulin (47.6%, p<0.01 vs. GPs). Medical students (n=40) were more likely to review diet and observe (42.5%, p<0.01 vs. GPs). Significant differences were observed between the 3 groups in what influenced their choice of therapy. GPs were most likely to take into account patient related factors such as patient's motivation to improve glycaemic control.

Conclusion: GPs were less likely to initiate insulin therapy, and our results suggest that this may be due to their greater awareness of patient related barriers to commencing insulin. These results justify support for continuing medical education of GPs that focuses on evidence based guidelines.