Clinical Topic Overview

Type 2 Diabetes

Primary care physicians are on the front lines of a diabetes epidemic. Approximately 24 million people—8 percent of the U.S. population—have diabetes, and approximately one-quarter of these cases are undiagnosed. The costs of the disease, in both human and economic terms, are vast. In addition to being the seventh leading cause of death in the U.S., it is the leading cause of blindness and kidney failure and is associated with 60 percent of all amputations. Heart disease mortality and stroke risk are two to four times higher among those with diabetes than those without. In economic terms, diabetes accounts for $174 billion in direct and indirect expenditures, including lost work days and productivity in the U.S.1 As the prevalence in the U.S. and around the world continues to rise,2, 3 these costs will only continue to grow.

Primary care physicians most frequently see patients at risk for and with type 2 diabetes. As such, they are in the best position to improve diagnosis and management of patients with type 2 diabetes. However, a 2009 needs assessment of primary care physicians conducted by PennCME/BestPractice revealed the following gaps:  

  • Physicians often fail to screen patients at risk for diabetes to improve rates of early diagnosis and treatment.

  • Inadequate glucose control as measured by regular administration of A1C tests and eye and foot exams to avoid and better manage complications of disease in type 2 patients.

  • Inadequate lipid management, BP control, depression screening, smoking cessation, and weight management guidance to minimize CV and CKD risks and manage other comorbid conditions in type 2 diabetes patients.

  • Physicians need to improve knowledge and understanding of treatment options, such as when to initiate insulin therapy and how to match patient needs and characteristics to the most appropriate antidiabetic agent.

  • Physicians need to address systems issues in their practices in order to provide integrated delivery of care to patients with type 2 diabetes.

  • Poor communication between patients and health care providers contributes to patient non-adherence to medication regimes, lifestyle changes and self monitoring. 

 
 
References:
1Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2008. Accessed on May 23, 2010. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf
2Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care.2004;27:1047-53.
3Fox CS, Pencina MJ, Meigs JB, et al. Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham Heart Study. Circulation. 2006;113:2914-

 

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