Adherence of Doctors to Diabetes Clinical Guidelines in Sudan

Hiba Salah Abdelgadir; Mustafa Magbol; Mogahid Salih Mohamed; Mohammed Ahmed Ibraheam; Hind Salah Abdelgadir; Mosab Abdelgader Ahmed

doi:doi:10.11648/j.jfmhc.20241003.13

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Adherence of Doctors to Diabetes Clinical Guidelines in Sudan

Hiba Salah Abdelgadir^*

, Mustafa Magbol

, Mogahid Salih Mohamed

, Mohammed Ahmed Ibraheam

, Hind Salah Abdelgadir

, Mosab Abdelgader Ahmed

Published in Journal of Family Medicine and Health Care (Volume 10, Issue 3)

Received: 2 August 2024 Accepted: 3 September 2024 Published: 26 September 2024

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Abstract

Background: Adherence to the clinical guidelines improves patients’ outcome by providing evidence-based care. This study aimed to assess adherence of doctors to diabetes clinical guidelines in Sudan. Method: A descriptive cross-sectional study was conducted from November 2022 to April 2023 on a purposive convenience sample of 465 doctors. Doctors’ adherence to diabetes guidelines was measured through an online questionnaire. Data was analyzed using frequency tables. The Chi square test used to determine associations between categorized variables. All statistical tests were considered statistically significant when p value < 0.05. Results: Of the 465 respondents, 76.8% were familiar with diabetes clinical guidelines, 72.7% of them implement guidelines recommendations, but only 46.5% were following the updated guideline recommendations. Only 44.5% of the surveyed doctors were aware of the local Sudanese diabetes guidelines. lack of regular training programs (17.9%), service cost (16.0%) and patients factors (15.6%) were the most common barriers to the guideline implementation. The adherence rate was positively associated with the job title, p value = 0.001. Conclusion: The study indicated low implementation to the updated diabetes guidelines among Sudanese doctors. To improve guidelines adherence, the study recommends launching training programs and continuous doctors’ assessment, along with issuing regulations and policies to ensure the use of the updated guidelines. The national guidelines need be well disseminated and regularly updated. Regular clinical audit and establishing the clinical governance are required to improve guidelines implementation in Sudan.

Published in	Journal of Family Medicine and Health Care (Volume 10, Issue 3)
DOI	10.11648/j.jfmhc.20241003.13
Page(s)	60-66
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Doctors, Diabetes, Clinical Guidelines, Adherence, Implementation, Sudan

1. Introduction

Diabetes mellitus (DM) is a metabolic disorder caused by elevation of sugar in blood (blood glucose). Is a chronic disease which can lead over time - if uncontrolled - to serious complications such as heart failure, kidney failure, eye complications and nervous system complications. Globally, diabetes is considered one of the major leading factors for morbidity and mortality

[1]

. There are about 422 million people worldwide diagnosed with diabetes according to the World Health Organization (WHO) statistics, and it is expected to reach 552 million by 2030

[2, 3]

. Diabetes is responsible of 1.5 million deaths each year and expected to be seventh leading cause of death by 2030

[4, 5]

Diabetes guidelines have been issued by many institutions, including, American Diabetic Association (ADA)

[6]

, National Institute for Health and Care Excellence (NICE)

[7]

, and International Working Group on the Diabetic Foot (IWGDF)

[8]

. Sudanese Diabetic Association developed local guidelines for diabetes management

[9]

Doctors face many problems during patients’ consultations. Guidelines are designed to assist doctors during their practice to treat and solve clinical problems

[10]

. Adherence of doctors to clinical guidelines helps them to provide high quality of care for their patients by providing them with updated treatment protocols

[11-14]

The main reasons for non-adherence to the clinical guidelines in developing countries are the absence of clinical governance and regular clinical audit

[14, 15]

. Clinical governance is important to deliver safety context and assurance of high care quality

[16]

. In developing countries, many efforts are required to increase the awareness of practicing doctors about clinical governance

[17, 18]

. Furthermore, policy makers must ensure implementation of the updated clinical guidelines

[11, 14]

. Adherence of doctors to the guidelines is important to ensure safe and cost-effective clinical care

[11, 16].

Doctors may face many problems that impede them form adherence of the guideline recommendations

[13, 19]

. Guidelines inaccessibility, volume of the guidelines, pressure from the patients and lack of resources are the most important factors of non-adherence to the guidelines

[14, 20]

. Other factors include guidelines disagreement, unexpected outcomes, time issues and lack of self-efficacy

[11, 14]

2. Methodology

2.1. Study Design

A cross-sectional study was conducted from November 2022 to April 2023 on a purposive convenience sample of 465 doctors. The surveyed doctors were working in the family medicine, internal medicine, emergency medicine, surgery and obstetrics and gynecology departments. Data was collected with the use of pre coded and pretested structured questionnaire. A pilot survey was conducted first, and then the questionnaire was modified accordingly. The collected data include the demographic characteristics of the surveyed doctors, their job titles, years of experience awareness of diabetes guidelines and factors related to adherence and implementation.

2.2. Statistical Analysis

The Statistical Package for Social Science (SPSS 22) was used. Results of the study were presented in frequency tables. Chi-square (X²) tests were used to assess the association between categorical variables. P value < 0.05 was considered statistically significant.

3. Result

Of the 465 surveyed doctors, (196, 42.2%) were in the age group (26 – 30 years), (279, 60%) were females. Most of the surveyed doctors (261, 56.1%) were house officers. Regarding the working department, most of the surveyed doctors were working in the internal medicine (100, 21.5%) and pediatrics (97, 20.9%) departments, as displayed in Table 1.

Most of the participants (271, 58.3%) had experience from 1- 5 years, and live in Khartoum (418, 89.9%), as displayed in Figures 1 and 2, respectively.

Table 1. Demographic characteristics of the participants, (n = 465).

Variables	Frequency	Percent (%)
Age groups:
20 – 25	193	41.5
26 – 30	196	42.2
31 – 35	42	9.0
36 – 40	19	4.1
>40	15	3.2
Gender:
Male	186	40.0
Female	279	60.0
Departments:
Internal medicine	100	21.5
Pediatric	97	20.9
Surgery	95	20.4
Obstetrics and gynecology	94	20.2
Emergency medicine	42	9.0
Family medicine	14	3.0
Other	23	4.9
Job title:
House officer	261	56.1
Medical officer	84	18.1
Registrar	99	21.3
Specialist	15	3.2
Consultant	6	1.3

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Figure 1. Distribution of the participants according to their experience years, (n = 465).

Download: Download full-size image

Figure 2. Distribution of the participants according to their residence, (n = 465).

Most of the surveyed doctors (357, 76.8%) were aware of the diabetes guidelines and reported that they implement the guidelines in their practice (338, 72.7%). Only (216, 46.5%) of the participants implement the updated guidelines recommendations. The awareness of the local Sudanese diabetes guidelines was reported only by (207, 44.5%) of the practicing doctors, Table 2.

Inaccessibility to the guidelines (203, 25.4%), too much of the guideline’s information (144, 18.0%), disagreement with specific guidelines (125, 15.6%) and frequent change of guidelines recommendations (123, 15.4%) were the common barriers that impede guidelines adherence, Table 3.

Irregular training programs (227, 17.9%), service cost (203, 16.0%) and patients factors (198, 15.6%) were the common guideline implementation barriers, Table 4.

Cross tabulation between guideline implementation and the demographic characteristics of the participants displayed significant association with the job title, p value (0.001) with consultants, specialists and registrars being more adherent to the guidelines than the house officers and the medical officers, Table 5.

Table 2. Distribution of the participants according to their awareness of diabetes guidelines, (n = 465).

Variable	Frequency	Percent (%)
Diabetes guidelines awareness:
Not aware	108	23.2
Aware	357	76.8
Diabetes guidelines implementation:
No	127	27.3
Yes	338	72.7
Following updated guidelines recommendations:
Not following	249	53.5
Following	216	46.5
Awareness of the local Sudanese diabetes guidelines:
Not aware	258	55.5
Aware	207	44.5

Table 3. Barriers to adherence to the clinical practice guidelines, (n =465).

Barriers	Frequency	Percent (%)
Guideline inaccessibility	203	25.4
Large volume of guideline information	144	18.0
Lack of agreement with specific guideline	125	15.6
Lack of agreement with guideline in general	75	9.4
Lack of outcome expectancy	61	7.6
Lack of Self-Efficacy	69	8.6
Regulatory change of guidelines recommendation	123	15.4

Table 4. Barriers to implementation of the clinical practice guidelines, (n = 465).

Barriers	Frequency	Percent (%)
Lack of time	100	7.9
Patient factors	198	15.6
Service cost	203	16.0
Lack of continuity in comprehensive care process	121	9.5
Service unavailability and inaccessibility	159	12.5
Lack of regular training programs	227	17.9
Absence of local treatment protocol or guideline	131	10.3
Health insurance factors	130	10.2

Table 5. Cross tabulation between guidelines implementation and the demographic characteristics of the guidelines, (n = 465).

Variables	Guidelines implementation		P value
Variables	No	Yes	P value
Gender:
Female	75	204	0.440
Male	52	134	0.440
Department:
Emergency medicine	9	33	0.297
Family medicine	2	12
Internal medicine	24	76
Obstetrics and gynaecology	26	68
Other	7	16
Paediatrics	24	73
Surgery	35	60
Job title:
Consultant	0	6	0.001
House officer	91	170
Medical officer	14	70
Registrar	18	81
Specialist	4	11

4. Discussion

Although many doctors reported good awareness (76.8%) and implementation of the diabetes guidelines (72.7%), updated diabetes clinical guidelines adherence was found to be very low (46.5%), which indicates diabetes management was not always coherent to updated recommendations. These results were similar with McGee et al. results, who indicated high rate of adherence to diabetes guidelines (79.9%)

[1]

. Similarly, Lu J et al. reported that guidelines adherence was (72.8%)

[21]

. Elisabetta et al. concluded that the guidelines implementation was lower than expected

[22]

Results of our study revealed that guideline inaccessibility (25.4%), guidelines large information (18.0%), disagreement with specific guidelines (15.6%) and frequent modification of guidelines recommendations (15.4%) were the common barriers to adherence to the guidelines. Irregular training programs (17.9%), service cost (16.0%) and patients factors (15.6%) were also stated as prominent barriers to the guideline’s implementation.

Abdelgadir et al. concluded that; the most reported barriers were guidelines unavailability and inaccessibility, patients’ factors, service cost, limitation of health insurance coverage, and the amount of information contained in guidelines

[11, 14]

. Similarly, Echlin et al. reported lack of time and inaccessibility as barriers to guidelines implementation

[23]

. Lugtenberg et al. found that disagreement with guidelines recommendations was the frequent barrier to guidelines adherence

[24]

Our study revealed a significant association between the job title and guidelines implementation (p value = 0.001). Similarly, Abdelgadir et al. concluded that high adherence was significantly correlated with the job titles (p value = 0.000), age (p value = 0.024) and clinical experience (p value = 0.012)

[11]

5. Conclusion

There is low implementation rate to the updated diabetes guidelines among Sudanese doctors. Our study identified a wide range of barriers to adherence and implementation of the diabetes guidelines. This demands barriers-tailored interventions to adopt the common barriers which include inaccessibility, volume of guidelines information, lack of training programs and costs of service. This could include regular issuing and dissemination of the updated Sudanese (national guidelines), launching regular training programs, introducing clinical audit, monitoring systems, and launching clinical regulations to bridge clinical governance gap and confirm the implementation of updated guidelines at all levels.

Abbreviations

ADA	American Diabetes Association
DM	Diabetes Mellitus
IRB	Institutional Review Board
IWGDF	International Working Group on the Diabetic Foot
MOH	Ministry of Health
NICE	National Institute for Health and Care Excellence
SPSS	Statistical Package for Social Science
WHO	World Health Organization

Declarations

Ethical approval was granted from Alzaiem Alazhari University Institutional Review Board (IRB) and the Sudan Ministry of health (MOH). Written informed consent was taken from each participant. Confidentiality and all rights were assured.

Acknowledgments

We would like to thank our families, friends and teachers for their help, guidance and support. Special thanks to Dr. Salah Abdelgadir Adelmagid for his guidance and support. Appreciations to M.s Samia Sawi for her support. Thanks and love to Firas Tatay and Leen Tatay.

Author Contributions

Hiba Salah Abdelgadir: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – review & editing

Mustafa Magbol: Data curation, Investigation, Methodology, Project administration, Writing – original draft

Mogahid Salih Mohamed: Investigation, Methodology, Project administration, Writing – original draft

Mohammed Ahmed Ibraheam: Investigation, Methodology, Project administration, Writing – original draft

Hind Salah Abdelgadir: Formal Analysis, Writing – review & editing

Mosab Abdelgader Ahmed: Reviewed, edited the final manuscript

Funding

The research was full funded by the authors.

Data Availability Statement

The data and materials are available upon request by direct contact with the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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Cite This Article

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APA Style

Abdelgadir, H. S., Magbol, M., Mohamed, M. S., Ibraheam, M. A., Abdelgadir, H. S., et al. (2024). Adherence of Doctors to Diabetes Clinical Guidelines in Sudan. Journal of Family Medicine and Health Care, 10(3), 60-66. https://doi.org/10.11648/j.jfmhc.20241003.13

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ACS Style

Abdelgadir, H. S.; Magbol, M.; Mohamed, M. S.; Ibraheam, M. A.; Abdelgadir, H. S., et al. Adherence of Doctors to Diabetes Clinical Guidelines in Sudan. J. Fam. Med. Health Care 2024, 10(3), 60-66. doi: 10.11648/j.jfmhc.20241003.13

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AMA Style

Abdelgadir HS, Magbol M, Mohamed MS, Ibraheam MA, Abdelgadir HS, et al. Adherence of Doctors to Diabetes Clinical Guidelines in Sudan. J Fam Med Health Care. 2024;10(3):60-66. doi: 10.11648/j.jfmhc.20241003.13

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@article{10.11648/j.jfmhc.20241003.13,
  author = {Hiba Salah Abdelgadir and Mustafa Magbol and Mogahid Salih Mohamed and Mohammed Ahmed Ibraheam and Hind Salah Abdelgadir and Mosab Abdelgader Ahmed},
  title = {Adherence of Doctors to Diabetes Clinical Guidelines in Sudan
},
  journal = {Journal of Family Medicine and Health Care},
  volume = {10},
  number = {3},
  pages = {60-66},
  doi = {10.11648/j.jfmhc.20241003.13},
  url = {https://doi.org/10.11648/j.jfmhc.20241003.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jfmhc.20241003.13},
  abstract = {Background: Adherence to the clinical guidelines improves patients’ outcome by providing evidence-based care. This study aimed to assess adherence of doctors to diabetes clinical guidelines in Sudan. Method: A descriptive cross-sectional study was conducted from November 2022 to April 2023 on a purposive convenience sample of 465 doctors. Doctors’ adherence to diabetes guidelines was measured through an online questionnaire. Data was analyzed using frequency tables. The Chi square test used to determine associations between categorized variables. All statistical tests were considered statistically significant when p value Results: Of the 465 respondents, 76.8% were familiar with diabetes clinical guidelines, 72.7% of them implement guidelines recommendations, but only 46.5% were following the updated guideline recommendations. Only 44.5% of the surveyed doctors were aware of the local Sudanese diabetes guidelines. lack of regular training programs (17.9%), service cost (16.0%) and patients factors (15.6%) were the most common barriers to the guideline implementation. The adherence rate was positively associated with the job title, p value = 0.001. Conclusion: The study indicated low implementation to the updated diabetes guidelines among Sudanese doctors. To improve guidelines adherence, the study recommends launching training programs and continuous doctors’ assessment, along with issuing regulations and policies to ensure the use of the updated guidelines. The national guidelines need be well disseminated and regularly updated. Regular clinical audit and establishing the clinical governance are required to improve guidelines implementation in Sudan. 
},
 year = {2024}
}

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TY - JOUR
T1 - Adherence of Doctors to Diabetes Clinical Guidelines in Sudan

AU - Hiba Salah Abdelgadir
AU - Mustafa Magbol
AU - Mogahid Salih Mohamed
AU - Mohammed Ahmed Ibraheam
AU - Hind Salah Abdelgadir
AU - Mosab Abdelgader Ahmed
Y1 - 2024/09/26
PY - 2024
N1 - https://doi.org/10.11648/j.jfmhc.20241003.13
DO - 10.11648/j.jfmhc.20241003.13
T2 - Journal of Family Medicine and Health Care
JF - Journal of Family Medicine and Health Care
JO - Journal of Family Medicine and Health Care
SP - 60
EP - 66
PB - Science Publishing Group
SN - 2469-8342
UR - https://doi.org/10.11648/j.jfmhc.20241003.13
AB - Background: Adherence to the clinical guidelines improves patients’ outcome by providing evidence-based care. This study aimed to assess adherence of doctors to diabetes clinical guidelines in Sudan. Method: A descriptive cross-sectional study was conducted from November 2022 to April 2023 on a purposive convenience sample of 465 doctors. Doctors’ adherence to diabetes guidelines was measured through an online questionnaire. Data was analyzed using frequency tables. The Chi square test used to determine associations between categorized variables. All statistical tests were considered statistically significant when p value Results: Of the 465 respondents, 76.8% were familiar with diabetes clinical guidelines, 72.7% of them implement guidelines recommendations, but only 46.5% were following the updated guideline recommendations. Only 44.5% of the surveyed doctors were aware of the local Sudanese diabetes guidelines. lack of regular training programs (17.9%), service cost (16.0%) and patients factors (15.6%) were the most common barriers to the guideline implementation. The adherence rate was positively associated with the job title, p value = 0.001. Conclusion: The study indicated low implementation to the updated diabetes guidelines among Sudanese doctors. To improve guidelines adherence, the study recommends launching training programs and continuous doctors’ assessment, along with issuing regulations and policies to ensure the use of the updated guidelines. The national guidelines need be well disseminated and regularly updated. Regular clinical audit and establishing the clinical governance are required to improve guidelines implementation in Sudan.

VL - 10
IS - 3
ER -

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Author Information

Hiba Salah Abdelgadir

Family Medicine, Community Medicine Department, Alzaiem Alazhari University, Khartoum, Sudan

Research Fields: Hiba Salah Abdelgadir: Family Medicine, Hypertension, Guidelines, Implementation, Chronic diseases, psychological impact

Contact Email

http://orcid.org/0000-0002-7456-0102
Mustafa Magbol

Community Medicine Department, Alzaiem Alazhari University, Khartoum, Sudan

Research Fields: Mustafa Magbol: Family Medicine, Hypertension, Guidelines, Implementation, Chronic diseases, Psychological impact

Contact Email

http://orcid.org/0000-0003-4777-4639
Mogahid Salih Mohamed

Community Medicine Department, Alzaiem Alazhari University, Khartoum, Sudan

Research Fields: Mogahid Salih Mohamed: Family Medicine, Hypertension, Guidelines, Implementation, Chronic diseases, Psychological impact

Contact Email

http://orcid.org/0009-0003-7636-0184
Mohammed Ahmed Ibraheam

Community Medicine Department, Alzaiem Alazhari University, Khartoum, Sudan

Research Fields: Mogahid Salih Mohamed: Family Medicine, Hypertension, Guidelines, Implementation, Chronic diseases, Psychological impact

Contact Email

http://orcid.org/0009-0004-0703-0082
Hind Salah Abdelgadir

Community Medicine Department, Alzaiem Alazhari University, Khartoum, Sudan

Research Fields: Hind Salah Abdelgadir: Family Medicine, Hypertension, Guidelines, Implementation, Chronic diseases, psychological impact

Contact Email

http://orcid.org/0009-0006-0018-9781
Mosab Abdelgader Ahmed

Community Medicine Department, Alzaiem Alazhari University, Khartoum, Sudan

Research Fields: Mosab Abdelgader Ahmed: Family Medicine, Hypertension, Guidelines, Implementation, Chronic diseases, psychological impact

Contact Email

http://orcid.org/0009-0003-7660-082X

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Plain Text BibTeX RIS

APA Style

Abdelgadir, H. S., Magbol, M., Mohamed, M. S., Ibraheam, M. A., Abdelgadir, H. S., et al. (2024). Adherence of Doctors to Diabetes Clinical Guidelines in Sudan. Journal of Family Medicine and Health Care, 10(3), 60-66. https://doi.org/10.11648/j.jfmhc.20241003.13

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ACS Style

Abdelgadir, H. S.; Magbol, M.; Mohamed, M. S.; Ibraheam, M. A.; Abdelgadir, H. S., et al. Adherence of Doctors to Diabetes Clinical Guidelines in Sudan. J. Fam. Med. Health Care 2024, 10(3), 60-66. doi: 10.11648/j.jfmhc.20241003.13

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AMA Style

Abdelgadir HS, Magbol M, Mohamed MS, Ibraheam MA, Abdelgadir HS, et al. Adherence of Doctors to Diabetes Clinical Guidelines in Sudan. J Fam Med Health Care. 2024;10(3):60-66. doi: 10.11648/j.jfmhc.20241003.13

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@article{10.11648/j.jfmhc.20241003.13,
  author = {Hiba Salah Abdelgadir and Mustafa Magbol and Mogahid Salih Mohamed and Mohammed Ahmed Ibraheam and Hind Salah Abdelgadir and Mosab Abdelgader Ahmed},
  title = {Adherence of Doctors to Diabetes Clinical Guidelines in Sudan
},
  journal = {Journal of Family Medicine and Health Care},
  volume = {10},
  number = {3},
  pages = {60-66},
  doi = {10.11648/j.jfmhc.20241003.13},
  url = {https://doi.org/10.11648/j.jfmhc.20241003.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jfmhc.20241003.13},
  abstract = {Background: Adherence to the clinical guidelines improves patients’ outcome by providing evidence-based care. This study aimed to assess adherence of doctors to diabetes clinical guidelines in Sudan. Method: A descriptive cross-sectional study was conducted from November 2022 to April 2023 on a purposive convenience sample of 465 doctors. Doctors’ adherence to diabetes guidelines was measured through an online questionnaire. Data was analyzed using frequency tables. The Chi square test used to determine associations between categorized variables. All statistical tests were considered statistically significant when p value Results: Of the 465 respondents, 76.8% were familiar with diabetes clinical guidelines, 72.7% of them implement guidelines recommendations, but only 46.5% were following the updated guideline recommendations. Only 44.5% of the surveyed doctors were aware of the local Sudanese diabetes guidelines. lack of regular training programs (17.9%), service cost (16.0%) and patients factors (15.6%) were the most common barriers to the guideline implementation. The adherence rate was positively associated with the job title, p value = 0.001. Conclusion: The study indicated low implementation to the updated diabetes guidelines among Sudanese doctors. To improve guidelines adherence, the study recommends launching training programs and continuous doctors’ assessment, along with issuing regulations and policies to ensure the use of the updated guidelines. The national guidelines need be well disseminated and regularly updated. Regular clinical audit and establishing the clinical governance are required to improve guidelines implementation in Sudan. 
},
 year = {2024}
}

Copy | Download

TY - JOUR
T1 - Adherence of Doctors to Diabetes Clinical Guidelines in Sudan

VL - 10
IS - 3
ER -

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