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Growing diabetes epidemic: Patient/physician disconnect on disease management

June 01, 2006

Diabetes experts share nationwide survey data, emphasize team approach

Washington, D.C. — Limited understanding of disease progression and frustration with disease management contribute to the clinical challenge of meeting the rising type 2 diabetes epidemic in America, according to the Diabetes Roundtable. The Roundtable, a multidisciplinary group of diabetes experts convened by the American Association of Diabetes Educators (AADE) and the American Association of Clinical Endocrinologists (AACE), with support from Merck & Co., Inc., calls for the medical community to take a more collaborative approach to caring for people with type 2 diabetes as a way to improve both disease management and outcomes.

A Harris Interactive (R) survey commissioned by AADE suggests a disconnect between what patients with type 2 diabetes and primary care physicians who treat the disease believe is the state of diabetes management. For example, two-thirds of patients (69 percent) say they feel very knowledgeable or knowledgeable about managing their condition. At the same time, 81 percent of physicians surveyed say they are frustrated with the number of their type 2 diabetes patients who do not follow their treatment regimen exactly as prescribed. The survey also shows gaps in understanding of the disease itself. Half of patients surveyed say they have little or no understanding of their A1C level or in the past six months have not had it checked or are unsure if they have had it checked. A1C is basic lab test for evaluating glucose control, an important aspect of diabetes management.

"We are dealing with some critical information gaps," said S. Sethu K. Reddy, M.D., M.B.A., F.A.C.E., F.A.C.P., chairman and program director of the Department of Endocrinology, Diabetes and Metabolism at The Cleveland Clinic and a member of the Diabetes Roundtable. "Type 2 diabetes is a chronic and complex disease, and for patients to self-manage their condition, it is useful for them to fully understand the basics of the disease and its progression—such as the role of declining pancreatic beta cell function. Yet, the majority (78 percent) of the primary care physicians surveyed say insulin resistance is the most important contributor to, and is primarily responsible for, the progression of type 2 diabetes in the majority of their patient population, with only 20 percent saying it is beta cell dysfunction. This suggests that primary care physicians do not consistently focus on how beta cells in the pancreas work, including as they relate to the incretin system. I also think most physicians don't clearly realize that beta cell function may play a role in determining how well patients respond to oral agents in diabetes."

The Roundtable advocates for improvements in the current diabetes care system, including the use of available resources to help patients best manage the disease. The survey shows 59 percent of patients surveyed have worked with a diabetes educator. Almost four in five patients surveyed (78 percent) who have not worked with a diabetes educator would like to learn something from one, including how to reduce the risk of diabetes complications (39 percent), strategies for healthy eating (38 percent), and information on new type 2 diabetes medications (33 percent). Additionally, the survey shows that diabetes educators have had a positive impact on how knowledgeable patients feel about managing their diabetes.

"We are not making the best use of our resources for managing type 2 diabetes. All too often patients feel they have 'failed' and feel guilty; physicians feel frustrated; no one wins," said Diabetes Roundtable member Donna Rice, M.B.A., R.N., B.S.N., C.D.E, wellness program manager, Botsford General Hospital, Novi, MI and president-elect of AADE. "Increasingly we recognize that a team-centered approach involving the patient, primary care physician, diabetes educator, behavioral scientist and endocrinologist provides the support and resources best needed to help patients manage the disease."

Members of the Roundtable believe care for people with type 2 diabetes could be enhanced by regular treatment from a team that aligns the latest in science, treatment options and education around lifestyle behavior change. In an effort to begin developing a roadmap to improve collaboration between the many areas of care directly involved in type 2 diabetes treatments, the Roundtable plans to work with other professional and patient groups to begin identifying potential solutions.

Porter Novelli