Physician Survey Reveals That Early Team Approach Is Best Medicine

Early management of type 2 diabetes with an integrated team of specialists, including a dietitian, diabetes educator, endocrinologist, cardiologist, and nephrologist, can significantly reduce the incidence of complications and lower healthcare costs, according to an online survey of more than 300 endocrinologists and family practice physicians. The survey was supported by Boehringer Ingelheim Pharmaceuticals, Inc., with the goal of determining the most common obstacles for physicians in treating type 2 diabetes patients and preventing complications. Sermo, the largest physician only online community, conducted the survey. A significant number of these physicians (44 percent) reveal that 50 percent of their patients develop at least one of the following serious complications: cardiovascular disease, nerve pain, kidney disease, stroke, blindness, or limb amputation.

The surveyed physicians (40 percent) do not believe that patients comprehend the significance of these complications, in particular kidney disease. "It's concerning that so many newly diagnosed patients are unaware that kidney problems are a common complication of type 2 diabetes. My patients often associate kidney damage with the need for dialysis, but they don't realize that the damage starts early on. Many people who are diagnosed with type 2 diabetes already have some degree of kidney impairment," states Dr. Mark Williams, clinical investigator and senior staff physician of the Joslin Diabetes Center and a member of the steering committee of the survey.

Dr. Vivian Fonseca is an endocrinologist with Tulane University Medical Center and a member of the survey steering committee. When asked how patients know if kidney complications are present, she stated, "Required annual testing for early stage type 2 diabetes patients includes a microalbumin urine test to measure kidney function. For type 2 diabetes, these tests should be done at diagnosis. For later stage type 2 diabetes patients, blood testing of kidney function needs to be added because filtration rates decline."

Awareness of kidney function impairment can lead to interventions to prevent other serious type 2 diabetes complications, such as heart disease. Type 2 diabetes patients are twice as likely to have heart attacks as those not affected. Heart disease among this population accounts for 50 percent of diabetes deaths.

The surveyed physicians reported that the lack of adherence to lifestyle modifications and medication and lack of motivation are the biggest factors in preventing complications. The intervention of dietitians/nutritionists within the integrated team is the most effective in helping patients lose weight, according to 63 percent of the participants. (Eighty-five percent of the people diagnosed with type 2 diabetes are overweight.) Dr. Fonseca stresses, however, that "the whole team is important, not a particular specialist. It is most important that physicians make appropriate referrals when complications arise." Physicians surveyed (93 percent) do not believe that other physicians are properly using the integrated team approach, although 83 percent of them believe that the team approach can prevent complications. The vast majority (71 percent) say the team approach is feasible within their practices. When asked if there are outcome differences between family medicine physicians and endocrinologists, Dr. Fonseca replied, "Not necessarily."