US Doctors and Patients “Not Connecting the Dots”

Reuters UK reports: Americans need more help managing diabetes.

The story, focusing mainly on Type 2 diabetes, suggests that “U.S. patients and doctors alike show a surprising level of ignorance about diabetes and are not doing nearly enough to manage the condition.”

Med_confusion This is particularly vexing news considering the other big D headline this week: “73 Million People in the U.S. Have Diabetes or Are At Risk.”

Don’t you love it when it takes a panel of international experts to identify the totally obvious? According to the group in the Reuters report, the primary troubles are:

* One doctor can’t do everything for a patient. We need medical insurance that will cover nurses, certified diabetes educators (CDEs), nutrionists and other providers

* A poll commissioned by an endocrinologists’ group and the American Association of Diabetes Educators surveying 780 patients and more than 400 primary care physicians identified a “disconnect” between what patients know about diabetes and what they actually do in real life

* Half of patients surveyed showed little or no understanding of their A1C level (that protein measurement indicating how well your blood sugar has been controlled for the past three months)

* “It’s like knowledge doesn’t equate to behavior change,” one doctor in Michigan says (!)

* The majority of the primary care physicians surveyed (78 percent) said insulin resistance is the most important contributor to progression of Type 2 diabetes. WRONG! The experts say the progressive damage of insulin-producing beta cells in the pancreas is likely a more important factor than insulin resistance

* “This suggests that primary care physicians do not consistently focus on how beta cells in the pancreas work,” notes that Michigan doctor

AHEM…

Why is it NEWS that following your doctor’s prescribed diabetes regimen (Type 2 or 1) is difficult in the Real World? Are patients in the UK really so much more proper? (perhaps…)

And has anyone ever visited a primary care physician for their diabetes and heard the term “beta cell”? If so, where can we find this extraordinary doc?

In any case, I’ll be attending the annual American Diabetes Association Conference in two weeks, and I’m hoping to interview beta cell research expert Dr. Camilo Ricordi there. I will surely ask him what, if anything, is being done to inform general practicioners around the country about beta cells and better treating diabetes?! And of course, I’ll be on the lookout for the medical community’s answers to this issue of patients “not connecting the dots”!

8 Responses

  1. Andrea Harris
    Andrea Harris May 31, 2006 at 6:31 pm | | Reply

    Here’s a question for Dr. Camilo Ricordi: If you were diagnosed with Type 1 today, and knew you still had SOME beta cell function left, what currently available treatment would you pursue today to attempt to preserve your remaining cells as long as possible?

    I know these researchers are working on amazing cures for the future, but I’d love to know what they would do today, if they needed to make a decision based on what’s currently available.

  2. AmyT
    AmyT May 31, 2006 at 8:31 pm | | Reply

    Ooh, Andrea, thanks for this.

    Anyone else care to submit questions for Dr. Ricordi?

  3. JasonJayhawk
    JasonJayhawk May 31, 2006 at 11:58 pm | | Reply

    Amy,
    Would you happen to have a reference source (article or website?) for the ADA comissioned poll about the disconnect between patients and their doctors? It’s just what I’m looking for as a reference in my MS Thesis, and would be a lovely item to add at this perfect timing. (No biggy if you can’t find it, though!)

  4. Nick
    Nick June 1, 2006 at 8:25 am | | Reply

    Another question for Dr. Ricordi:
    Does a reliable clinical procedure exist for testing whether or not an insulin-dependent patient still has living, functioning beta cells in vivo?

  5. Kelsey
    Kelsey June 1, 2006 at 8:27 am | | Reply

    The one doc that ever talked to me about beta cells was a type 1 diabetic himself! That sure tells you something…

  6. AmyT
    AmyT June 1, 2006 at 8:51 am | | Reply

    Jason,
    The study was actually commissioned by the American Assoc. of Clinical Endocrinologists (AACE). Here’s the link:
    http://www.aace.com/newsroom/press/2005/index.php?r=20050518_2

  7. Scott
    Scott June 1, 2006 at 2:48 pm | | Reply

    Interesting. On May 3, 2006, a report released by Quest Diagnostics, the nation’s largest clinical laboratory chain, reported that people with diabetes who visit health professionals are actually doing a BETTER job of managing their disease, according to results from the Quest Diagnostics Health Trends (TM) Diabetes Report. The report did find that nearly half of all test results in 2005 were still above the target goal for diabetes control set by the American Diabetes Association (ADA), but the results were better than the previous year.

    See URL for this press release:
    http://www.prnewswire.com/news/index_mail.shtml?ACCT=104&STORY=/www/story/05-03-2006/0004353998&EDATE= for the news release on Quest’s findings.

    Nevertheless, I think all this conflicting data suggests there is too much research on the state of diabetes care, and not enough action on why these problems exist. Perhaps their research priorities need re-prioritization with more dollars and efforts going into cures?! Dare to dream!

  8. Hamish
    Hamish June 5, 2006 at 1:03 pm | | Reply

    Re UK doctors and patients, we have a similar system in the UK to HMO here. You have to go to your GP first, which is free as they are NHS doctors, and they are the gatekeepers to your being referred to a specialist. You cannot go direct to a specialist unless you’re going to pay the whole bill yourself. There’s no PPO. If you have private medical insurance (most people in the UK do not) then your GP will be much happier to refer you on – a patient off their workload and off their budget. But if you don’t have insurance, most GPs will treat your diabetes themselves. Specialists cost the NHS a lot of money and you need something far “worse” than diabetes to go see one. My own experience with my GP, at my first visit before getting referred, was a glib “have a go at a low GI diet, you’ll find lots of information in the internet about that, and we’ll see how it goes”. Oh, as well as a one page hand out on his recommended “mediterranean diet”. Despite presenting with fasting BG in the 300′s in my 30′s weighing 180lbs at 6′ 1″, as far as he was concerned this was classic type 2 and the treatment was eat less and move around more. The thought of leaving myself in his hands to determine my subsequent medication and insulin regime is frankly terrifying. Thankfully the words “I have insurance and I’m leaving the country in two months” got me referred like a shot.

    Re the British as patients, next time you’re on vacation in London, look for all the young people smoking. It’s quite amazing how prevalent it still is. If we can’t quit the smokes, how much better will we be at managing diabetes?

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