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QJM. 2011 Sep;104(9):761-6. doi: 10.1093/qjmed/hcr046. Epub 2011 Apr 21.

Lack of confidence among trainee doctors in the management of diabetes: the Trainees Own Perception of Delivery of Care (TOPDOC) Diabetes Study.

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Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.



There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care.


To determine levels of confidence of doctors in training in the management of diabetes and establish their training needs in this area of clinical practice.


A national online survey of trainee doctors in the UK using a pre-validated questionnaire.


A four-point confidence rating scale was used to rate confidence in the management of diabetes and comparators. A six-point scale was used to quantify how often trainees would contribute to the management of patients with diabetes and trainees were asked about their training in managing diabetes.


A total of 2149 doctors completed the survey. The percentage 'fully confident' in diagnosing diabetes was 27%, diagnosing and managing hypoglycaemia 55%, diagnosing and managing diabetic ketoacidosis 43%, managing intravenous (IV) insulin 27%, prescribing IV fluids for patients with diabetes 39% and altering diabetes therapy prior to surgery/other procedure 18%. In comparison, 66% and 65% were 'fully confident' in the management of angina and asthma, respectively (P < 0.05). Forty-one percent would take the initiative to optimize glycaemic control for patients under their care >80% of the time. Respectively, 19% and 35% of respondents reported that their undergraduate and postgraduate training had prepared them adequately to optimize treatment of diabetes. The majority (>70%) wanted further training in managing all aspects of diabetes care.


Trainee doctors in the UK lack confidence in the management of diabetes, are unlikely to take the initiative to optimize glycaemic control and report a need for further training.

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