Management of diabetes may be inconsistent

AORN Journal, Oct, 2006

Results from a survey of patients with type 2 diabetes and physicians who treat the disease indicate that understanding of disease progression is limited and there is a disconnect between what patients and physicians believe is the state of diabetes management, according to a May 31, 2006, news release from the American Association of Diabetes Educators and the American Association of Clinical Endocrinologists. Patients with diabetes can have an increased risk for mortality and can develop heart disease, kidney disease, blindness, and vascular or neurological problems that can lead to amputation. Diabetes affects 19.3 million people in the United States, with type 2 diabetes accounting for 90% to 95% of the cases.

The survey showed that physician understanding of the pathophysiology of type 2 diabetes may be inconsistent. For example, although the incretin system plays an important part in regulating brood sugar levels, 51% of physicians said that the incretin system is only somewhat important or is not at all important in regulating brood sugar levels. In addition, although beta celt dysfunction is a large contributor to progression of type 2 diabetes, only 20% of physicians believed it was the most important contributor to type 2 diabetes progression in their patient population, compared to 78% of physicians who named insulin resistance as the most important contributor to disease progression.

Of additional concern is an apparent disconnect between how well patients think they are self-managing their diabetes and how well physicians think their patients are self-managing the disease. For example, 83% of patients who said they eat a healthy, balanced diet thought they followed their health care providers' instructions well or very well, but only 29% of physicians believed this to be the case. Of patients who engaged in regular physical activity, 77% said they comply well or very well with their hearth care providers' instructions for getting regular physical activity, but only 18% of physicians said this is the case with their patients.

Although 69% of patients with diabetes said they felt knowledgeable or very knowledgeable about managing their condition, 59% believed that their diabetes was only somewhat or not at all well controlled. Glucose control is an important aspect of diabetes management, and A1C is a basic laboratory test for evaluating glucose control. More than half of the patients surveyed, however, had tittle or no understanding of their A1C fever or had not had it checked or were unsure if they had had it checked in the past six months.

The survey also showed that 59% of patients surveyed had worked with a diabetes educator and that diabetes educators had a positive impact on how knowledgeable patients felt about managing their diabetes. Of those patients who had not worked with a diabetes educator, 78% said they would like to team something from one, including

* how to reduce the risk of diabetes complications (ie, 39%);

* strategies for healthy eating tie, 38%); and

* information on new type 2 diabetes medications (ie, 33%).

Growing Diabetes Epidemic: Patient/Physician Disconnect on Disease Management (news release, Chicago and Jacksonville, Fla: American Association of Diabetes Educators and American Association of Clinical Endocrinologists, May 31, 2006).