Friday, May 17, 2013

I believe , the key to success in a persons diabetes care is ____?____ .


I will review some of the abstracts from the recent American Association of Clinical Endocrinologists annual meeting over the next week.
#1

BARRIERS TO INSULIN INITIATION IN TYPE 2
DIABETES MELLITUS - A SINGLE INSTITUTION
STUDY AMONG THE PHYSICIANS
Kelly Khai Li Yap, M.D., Yiyi Yan, Aruna Chelliah
York Hospital

The study included 1226 patients with Type 2 Diabetes with 273 with  A1c results  greater than 8.5%. Among these 273 patients , 119 were not on insulin. A survey was conducted among the primary care physicians treating these patients to investigate the barriers insulin initiation .

Results;
 45 % of the physicians responded
 80 % of the responding physicians believed insulin was efficacious
 90 % disagreed that insulin should be started by a endocrinologist
 66 % chose to delay insulin therapy because it was to burdensome for their patients
 60 % said that insulin therapy was to complicated for their patients and more than 50% said the variety
          of insulin products lead to confusion.

Conclusion:
" Our study suggests that education is the key to improving glycemic control and insulin usage among
   patients managed by their PCPs."


My opinion:
   Type 2 diabetes is a progressive disease leading to insulin deficiency and the need for insulin replacement . The convenience of oral diabetes medication and the increase complexity and risk of hypoglycemia with insulin is certainly a big factor  in delaying insulin use . Also , many people on insulin still do not  reach recommended target goals . A good example is , this study, 56%  of  patients  were on insulin and  still had  an A1c greater than 8.5 % in order to qualify for this survey.

   Looking at the data in studies like this does does not show the full picture of the long term diabetes management . It is easy to set and achieve ideal target goals for A1c , blood pressure and the other 7 risk factors in the ideal patient. Unfortunately many of us do not fall into that category . Age , general life situation and medication cost play an important role in trying to achieve ideal diabetes management. One size  certainly does not fit all . It is important to remember , test result that are perfect for your neighbor may not be the best one for you.

   The  above problems in diabetes management  was one of the main reason for me writing ,  Diabetes Office Visit  and developing this web site . I believe , the key to success in a persons diabetes care is a well informed patient wanting to preserve their good health  blended with the knowledge and wisdom of their health care provider .  Setting , reaching and maintaining target goals in diabetes care is the secret to maintaining good health.

Know your treatment goals:
  The informed patient knows the American Diabetes Association  recommended goals and their 
  health care provider has the wisdom to help fit those goals into his / her individual life situation.

Ask for a copy of your laboratory test results.

Knowing your treatment goals simplifies your health care
    If your laboratory or exam result is not at  the mutually agreed goal .

  Ask a simple question.
    Doc. ( or other health provider ) , my test is not at our mutually agreed upon goal .

  Can you help me fix it ?

Have fun , Be Smart and Check out the Diabetes Office Visit video above.
David Calder , MD

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You can find all of the tools to improve your diabetes care in , Diabetes Office Visit . Available in paper back , iphone and ipad apps.

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Your comments and questions are appreciated. David Calder,MD