Study Identifies Gaps in Diabetes Treatment

Philadelphia—As the prevalence of diabetes continues to expand, the need for evidence-based management is becoming increasingly crucial. A study identified several clinical aspects of management of type 2 diabetes that warrant more education for healthcare providers. Study data were presented at the ADA meeting during a poster session titled Current Practice Patterns in Managing Patients with Type 2 Diabetes.

To determine the comprehensive education needs for diabetes care providers, a survey was developed to gather information from a broad range of US healthcare providers (n=974) to assess current practice patterns and perspectives of these providers related to the management of type 2 diabetes. The survey participants included endocrinologists (n=150), family physicians (n=150), internists (n=151), physician assistants (n=126), nurse practitioners (n=125), certified diabetes educators (CDEs, n=121), retail pharmacists (n=100), and hospital pharmacists (n=51). The survey items used a 10-point Likert scale (1=least, 10=most) to evaluate perceptions of management of patients with diabetes. The surveys were distributed electronically in July 2011.

The survey found fewer than half of primary care physicians (33% for family physicians and 34% for internists) and <10% of pharmacists (8% for hospital pharmacists and 7% for retail pharmacists) are very familiar with ADA guidelines. These groups also lack comfort in using insulin forms other than long-acting basal analogs. Furthermore, family physicians (11%), internists (19%), physician assistants (16%), and nurse practitioners (14%) are not likely to refer to endocrinologists if insulin is needed. Instead, >50% of these groups are more likely to refer to a CDE if insulin is required (56% for family physicians, 54% for internists, 58% for physician assistants, and 51% for nurse practitioners).

When asked about barriers to patient care, high carbohydrate cultural diets and the use of different languages were identified as cultural barriers. For example, 53% of endocrinologists identified high carbohydrate cultural diets and 35% of retail pharmacists reported language differences as primary cultural barriers. Healthcare professionals are also concerned with the patient’s level of understanding diabetes management.

The researchers noted that endocrinologists and CDEs are more knowledgeable about the mechanism of action of new diabetes therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors. Furthermore, both of these groups were most likely to add a GLP-1 to an obese patient’s multiple oral antidiabetic regimen (54% and 42%, respectively).

Educational areas to target in the management of type 2 diabetes patients were somewhat similar for both specialists and primary care physicians. The researchers, however, were not surprised that more gaps existed in the primary care population. The investigators recommended educational initiatives to improve healthcare professionals’ management of type 2 diabetes:

•Reviews of guideline recommendations for all providers is warranted, with emphasis for primary care providers and pharmacists

•Reviews on the use of different insulin formulations would benefit primary care physicians

•Reviews of the latest safety and efficacy data of diabetes therapies would be beneficial, with a focus on how and when to incorporate GLP-1 and DPP-4 inhibitor agents into treatment regimens

•Because all groups perceive high carbohydrate cultural diets as a major barrier, development of strategies to address the issue with patients would be helpful

“Practice pattern data from this study and similar ones like it can be used to inform development of educational initiatives,” concluded the researchers. “It is our hope that it will be used to improve provider performance, leading to improved patient outcomes.”

This study was supported by Novo Nordisk.