[PHNUTR-L] Growing diabetes epidemic: Patient/physician disconnect on disease mgmt

[Kathrynne Holden, MS, RD]

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Public release date: 31-May-2006
http://www.eurekalert.org/pub_releases/2006-05/pn-gde053106.php

Contact: Julia Gendler
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Porter Novelli

Growing diabetes epidemic: Patient/physician disconnect on disease 
management

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.

###

For further information on the outcomes of the Roundtable meeting and 
survey results, visit www.diabetesteamsite.com.

About the Diabetes Roundtable
AADE and AACE convened the Diabetes Roundtable in April 2006, to discuss 
ways to improve outcomes for type 2 diabetes. The multidisciplinary 
group of health care professionals includes experts in endocrinology, 
diabetes education, primary care and behavioral science. In addition to 
Dr. Sethu Reddy and Donna Rice, other members of the Roundtable are: 
Susan Cornell, Pharm.D., B.S., C.D.M., C.D.E., clinical assistant 
professor, Midwestern University, Downers Grove, IL; Silvio Inzucchi, 
M.D., professor of medicine, Section of Endocrinology, Department of 
Internal Medicine, Yale University, Director, Yale Diabetes Center, New 
Haven, CT; Edwin Fisher, Ph.D., chair, Health Behavior and Health 
Education, University of North Carolina, Chapel Hill, NC; and Doron 
Schneider, M.D., associate program director of the Internal Medicine 
Residency and Medical Director of the Ambulatory Services Unit, Abington 
Memorial Hospital, Abington, PA. The nationwide survey and the Diabetes 
Roundtable were supported by a grant from Merck & Co., Inc.
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