[PHNUTR-L] Diabetes knowledge has little effect on improving
Kathrynne Holden, MS, RD
fivestar at nutritionucanlivewith.com
Fri Jun 3 05:39:36 PDT 2005
Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
Public release date: 2-Jun-2005
Contact: Richard Merritt
Merri006 at mc.duke.edu
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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