[PHNUTR-L] Diabetes knowledge has little effect on improving outcomes

[Kathrynne Holden, MS, RD]

Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
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Public release date: 2-Jun-2005
http://www.eurekalert.org/pub_releases/2005-06/dumc-dkh060205.php

Contact: Richard Merritt
Merri006 at mc.duke.edu
919-684-4148
Duke University Medical Center

Diabetes knowledge has little effect on improving outcomes

DURHAM, N.C. – A new study by Duke Clinical Research Institute 
researchers finds little relationship between what a diabetic patient 
knows about the disease and control of its associated cardiovascular 
risk factors or how well the patient ultimately fares.

The researchers said their analysis indicates that for diabetics, 
improved disease knowledge alone does not translate into improved blood 
sugar control, cholesterol levels, weight management or mortality rates. 
While education may be important, the researchers said that there are 
likely other health care delivery issues that must be addressed to 
reduce the risks of diabetic patients dying of heart disease, the main 
cause of death for diabetic patients.

The results of the Duke analysis were published in the June edition of 
the American Journal of Cardiology. The study was supported by the 
American Diabetes Association and the Four Schools Physician-Scientist 
Training Program, Philadelphia.

"We have long assumed that if we educate patients and make them an 
active partner in the treatment of their disease, we should be able to 
dramatically improve their ability to take care of their disease," said 
Carlos Sanchez, M.D., first author of the paper. Sanchez performed the 
analysis while a medical student at Duke; he currently is a medical 
resident at the University of Oregon Health Sciences Center, Portland. 
"However, in our study, we found no relationship between patients' 
knowledge of their disease and improvements in the indicators for 
cardiovascular risk factors.

"We spend so many resources on patient education with the assumption 
that it will make a difference, but what we seem to be finding is that 
while education may be a part of the puzzle, it is not adequate by 
itself," Sanchez continued. "Maybe we should step back and take a closer 
look at how we are spending our resources. One area that could be 
improved is better implementation of guidelines for increasing the use 
of medications we know save lives."

Patients with diabetes are twice as likely as the general population to 
have acute coronary syndrome (ACS), a condition characterized by 
blockages in coronary arteries that prevent oxygen-rich blood from 
nourishing the heart, which can lead to chest pain and possibly heart 
attack. Additionally, diabetic patients with ACS have twice the death 
rate as ACS patients without diabetes.

For their study, the team enrolled 200 diabetic patients who were 
treated at Duke University Hospital for ACS. At enrollment each patient 
took a standardized test that measured his or her knowledge related to 
diabetes. The 14-question assessment asked about dietary and life style 
choices related to glycemic and lipid control, as well knowledge of the 
effects of the disease on other organ systems. Patients were then ranked 
as either high-scoring or low-scoring.

Six months later the researchers correlated how each of the groups 
scored with such clinical measurements as glycemic control, cholesterol 
levels, body mass index (BMI) and death. The only correlation, not 
surprisingly, was that diabetes-related knowledge scores increased as 
years of education increased.

"However, even when we controlled for other potential confounding 
factors as age, race, insulin requirements, and how long patients had 
diabetes, we found no correlation between the two groups and 
measurements of glycemic control, cholesterol levels and BMI," Sanchez said.

Furthermore, in a subset of patients who returned finger-stick blood 
samples, the team found no difference in measurements of glycemic 
control. "We found this quite interesting, since these patients had been 
hospitalized and recovered from a life-altering event, yet there was no 
difference between the groups in terms of glycemic control."

In terms of mortality, the high-scoring group had a 6-month mortality 
rate of 6.2 percent, compared to 9.7 percent for the low-scoring group. 
In terms of heart attacks, 15.5 percent of the high-scoring group 
suffered at least one, compared to 19.4 percent for the low-scoring 
group. The differences in both the death and heart attack rates were not 
statistically significant, the researchers said.

Because of these findings, the researchers said that further studies are 
needed to determine how best to allocate scarce health care resources to 
reduce the cardiovascular risk factors facing diabetics.

"Delays in identifying the disease, failure to begin appropriate 
medications and inadequate dosing are all well-documented shortcomings 
of our health care system," Sanchez said. He pointed out, for example, 
that on enrollment to the study, only two-thirds of the patients were 
taking medications that have been proven in clinical trials to improve 
the outcomes for diabetics with heart disease. These drugs include 
aspirin, beta blockers, ACE inhibitors and statins.

Duke cardiologist Kristin Newby, M.D., a senior member of the research 
team, said that while patient noncompliance, whether because of 
financial or psychosocial reasons, plays an important role in the 
under-treatment of heart disease in these patients, physicians' 
prescription of appropriate medications and the health care delivery 
system must also play leading roles in improving outcomes.

"These findings indicate that we may need to shift some of our focus in 
managing diabetes and its complications," said Newby. "Much of the 
diabetes efforts tend to focus on the microvascular changes caused by 
the disease: the loss of vision, kidney function or loss of limbs. 
However, heart disease is the leading cause of death for diabetics.

"Although education and prevention of microvascular complications are 
important, we need to markedly increase efforts to ensure that health 
care systems are in place to promote both the delivery of evidence-based 
care in accordance with existing guidelines and long-term adherence to 
therapies that are proven to prevent heart attacks and death from heart 
disease," she said.

Other members of the team include Duke's Vic Hasselblad, Ph.D., Mark 
Feinglos, M.D., and Mognus Ohman, M.D; and Darren McGuire, M.D., 
University of Texas Southwestern Medical Center, Dallas. All are members 
of the Duke Clinical Research Institute.
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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