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Senior Citizen Health & Medicine
Diabetes Epidemic Faces Patient-Physician Disconnect
Experts say survey points to need for team
approach to treatment
May 31, 2006 - Limited understanding of diabetes
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 group 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. More than 20 million Americans suffer with diabetes and
about half of these are senior citizens age 60 and over.
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Health & Medicine |
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The Roundtable, a multidisciplinary group of
diabetes experts was convened by the American Association of Diabetes
Educators (AADE) and the American Association of Clinical
Endocrinologists (AACE), with support from Merck & Co., Inc.
A Harris Interactive 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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National Diabetes Fact Sheet
(PDF)
This is the official Fact Sheet developed jointly by the Centers
for Disease Control and Prevention, the National Institutes of
Health, the American Diabetes Association, and other partners.
The Fact Sheet is the authoritative source of information,
statistics, and national estimates on diabetes in the United
States. |
About Type 2 Diabetes
Type 2 diabetes is a condition in which the body has elevated blood
sugar or glucose. With type 2 diabetes, the body may not make enough
insulin (which helps the body use glucose), the insulin that the body
produces may not work as well as it should, or the body may make too
much glucose. Patients with diabetes can develop heart disease, kidney
disease, blindness, vascular or neurological problems that can lead to
amputation and they can be at risk for increased mortality.
19.3 million people in the United States
have diabetes, with type 2 diabetes accounting for 90 to 95 percent of
the cases. It is estimated that one in three Americans born in 2000 will
develop diabetes sometime during their lifetime. There are currently
more than 194 million people with diabetes worldwide, and if nothing is
done to slow the epidemic, the number will exceed 333 million by 2025.
About the Survey
The patient survey by Harris Interactive was conducted between April 6
and 14, 2006, among 784 adults (aged 18 and over) diagnosed with type 2
diabetes within the United States. Figures for age, sex, race/ethnicity,
education, region and household income were weighted where necessary to
bring them into line with their actual proportions in the population.
Propensity score weighting was also used to adjust for respondents'
propensity to be online. Propensity score adjustment via weighting
allows us to adjust for attitudinal and behavioral differences between
those who are online versus offline, those who join online panels versus
those who do not, and those who responded to this survey versus those
who did not.
The primary care physicians (PCPs)
survey was conducted between April 7 and 12, 2006, among 406 PCPs who
see at least three type 2 diabetes patients per month. Figures for sex,
years in practice, and region were weighted where necessary to bring
them into line with their actual proportions in the population. These
results were not propensity weighted.
With pure probability samples, with 100
percent response rates, it is possible to calculate the probability that
the sampling error (but not other sources of error) is not greater than
some number. With a pure probability sample of 784 patients one could
say with a 95 percent probability that the overall results have a
sampling error of +/- 5.3 percentage points, while the error rate for
406 physicians is +/- 6.6 percentage points. Sampling error for the sub
samples for each group is higher and varies. Each of the online surveys
is not based on probability samples and therefore no theoretical
sampling error can be calculated.
About AADE
Founded in 1973, the AADE is a multi-disciplinary professional
membership organization dedicated to promoting the expertise of the
diabetes educator, ensuring the delivery of quality diabetes
self-management training to the patient and influencing and contributing
to the future content and direction of the profession. The AADE mission
is to drive professional practice to promote healthy living through
self-management of diabetes and related conditions.
About AACE
AACE is a professional medical organization with more than 5,300 members
in the United States and 85 other countries. Founded in 1991, AACE is
dedicated to the optimal care of patients with endocrine problems. AACE
initiatives inform the public about endocrine disorders. AACE also
conducts continuing education programs for clinical endocrinologists,
physicians whose advanced, specialized training enables them to be
experts in the care of endocrine disease, such as diabetes, thyroid
disorders, growth hormone deficiency, osteoporosis, cholesterol
disorders, hypertension and obesity.
About Merck
Merck & Co., Inc. is a global research-driven pharmaceutical company
dedicated to putting patients first. Established in 1891, Merck
currently discovers, develops, manufactures and markets vaccines and
medicines to address unmet medical needs. The Company devotes extensive
efforts to increase access to medicines through far-reaching programs
that not only donate Merck medicines but help deliver them to the people
who need them. Merck also publishes unbiased health information as a
not-for-profit service. For more information, visit
www.merck.com.
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