Impact of academic-detailing on blood-sugar control in type-2 diabetics in the Auvergne region

Aim: Between May 31, 1999 and December 31, 1999, physician-advisors salaried by the French health insurance fund provided academic-detailing visits to prescribing physicians in order to promote the guidelines on the follow-up of patients with type-2 diabetes mellitus. The aim of our study was to measure the immediate and long-term impact of these visits in terms of blood-sugar control in diabetic patients in Auvergne. Method: We used patient reimbursement data from a first weekly series to identify patients who received at least one oral anti-diabetic agent and a second weekly series to identify patients receiving at least one oral anti-diabetic agent who also had at least one glycosylated hemoglobin-A (HbA1c) determination. All the enrolled patients were affiliated stricto sensu with the general scheme of the French health insurance fund in Auvergne. We transformed the data into a 100 base index in order to be able to compare the series. Results: By the end of the academic-detailing visits, we saw a significant increase in the average weekly number of diabetics who had had a HbA1c determination, which increased from 663 (standard deviation:66) in May-June 1999, to 850 (standard deviation:118) in November-December 1999. This increase, which persisted into December 2002, was more pronounced than the corresponding increase in diabetic morbidity. Conclusion: Academic-detailing played a part in the improvement in blood-sugar control of diabetic patients in Auvergne. This method can be useful for improving the quality of the subsequent laboratory follow-up in chronic disorders when the medical decision in initially made.