Open Access Research article

Awareness, agreement, adoption and adherence to type 2 diabetes mellitus guidelines: a survey of Indonesian primary care physicians

Indah S Widyahening12*, Yolanda van der Graaf2, Pradana Soewondo3, Paul Glasziou4 and Geert JMG van der Heijden5

Author Affiliations

1 Community Medicine Department, Faculty of Medicine Universitas Indonesia, Jl. Pegangsaan Timur 16, Jakarta 10430, Indonesia

2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

3 Internal Medicine Department, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Diponegoro 71, Jakarta 10430, Indonesia

4 Centre for Research in Evidence-Based Practice (CREBP) Faculty of Health Sciences, Bond University, Gold Coast, Queensland 4229, Australia

5 Department Social Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands

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BMC Family Practice 2014, 15:72  doi:10.1186/1471-2296-15-72

Published: 23 April 2014



To assess the degree of awareness, agreement, adoption and adherence of physicians in Indonesia to type 2 diabetes mellitus guidelines, and their association with characteristics of the responders.


Questionnaire survey among General Practitioners (GPs) attending the Indonesian Association of Family Practitioners annual conference in November 2012. The proportion of GPs who were aware of, agreed with, adopted and adhered to the seven recommendations in the guidelines (screening for diabetes, diagnosis, lifestyle modification, use of sulfonylurea, target blood glucose, target blood pressure and use of statin) were calculated in the total number of responders.


Of the 399 GPs participating, 383 (89%) were aware of the existence of Indonesian type 2 diabetes guidelines. Awareness for each recommendation varied from 66 to 91%. The recommendation to use a random blood glucose test for diagnosing patients with classic diabetes symptoms had the least awareness (265/399, 66%) and least agreement (163/399, 41%). The recommendation on statin use was the least adopted (192/399, 48%), while the least adherence (7/399, 2%) was found for the recommendation on screening for diabetes for patients with risk factors. Years of practice experience and proportion of diabetes patients seen in their practice were independently related with adherence to statin prescription.


High awareness of the Indonesian type 2 diabetes guideline does not necessary lead to adoption or adherence to recommendations important for outcomes and quality of care. The awareness-to-adherence model helps in identifying barriers for the use of guidelines.

Awareness; Adoption; Adherence; Diabetes; Guidelines; General practitioners