SHIELD: Implementation, not education is key to diabetes management

ADA 71st Scientific Sessions

SAN DIEGO — Although patients with type 2 diabetes are well aware of the important aspects of diabetes management, such as appropriate nutrition and physical activity, many struggle to implement these lifestyle changes, according to the 5-year results of the SHIELD study.

The Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD) examined the attitudes, behaviors and knowledge of diabetes and risk factors for the disease via survey. Researchers queried 22,000 people with and without diabetes, and had a response rate of 70% per year during a 5-year period.

Most people with or without diabetes understood the association between obesity and the disease, but only a minority followed a specified eating plan or engaged in routine physical activity. According to study researcher Harold E. Bays, MD, medical director and president of Louisville Metabolic and Atherosclerosis Center, the SHIELD study suggested that many patients with diabetes knew the adverse health consequences of too much body fat, but this knowledge often did not result in lifestyle changes.

"As providers, our first inclination is to blame ourselves when patients fail to achieve desired goals. But it is ultimately the patient who must decide what they are willing to do," Bays said. "We certainly should continue to empower patients with appropriate medical education and management tools. However, once patients are provided the power, whether they choose to turn on and use their power will ultimately determine if their knowledge translates into actionable behavior."

Despite the lack of action in managing their disease, results indicated that respondents had good access to health care. Approximately 90% of participants reported visiting a physician at least three times in the previous year, Andrew J. Green, MD, director of Midwestern Endocrinology in Overland Park, Kan., said during a symposium. Access to primary care physicians and specialists was similar. A much greater percentage of people with diabetes who saw health educators stated that their health had improved in the past year when compared with those who had not met with a health educator.

A large proportion attempted weight loss at some period in time. However, only 33% with the disease reported success in maintaining their ideal weight. Approximately 80% of the entire population attributed their difficulty with weight maintenance to diet, yet only one-third of people with type 2 diabetes on a prescribed diet reported actually following the specific eating plan. An even greater proportion of respondents were told to exercise by their physicians; nevertheless, only 12.7% of people with diabetes reported being physically active.

Helena W. Rodbard, MD, an endocrinologist in private practice in Rockville, Md., determined risk factors for transition to diabetes. During the 5-year study, 6.8% of 10,825 participants she analyzed were diagnosed with diabetes. Increasing age, high blood glucose without current diagnosis of diabetes, gestational diabetes, obesity, abdominal obesity, excessive thirst, asthma and family history were highlighted as risk factors for receiving a diagnosis of diabetes. In contrast, patients who were perceived to be of good to excellent health were less likely to transition to diabetes during the course of the study.

Helena W. Rodbard

Of the 200,000 households that received the screening questionnaire in 2004, 127,420 households containing 211,097 adults returned completed questionnaires. The follow-up baseline survey was mailed to 22,001 respondents who were followed over the subsequent 5 years with annual surveys.

Regarding the clinical implications of these data, James R. Gavin III, MD, PhD, of Emory University, stressed that the SHIELD study demonstrates that educational efforts have been successful among patients with type 2 diabetes. However, translation of this knowledge into action is the primary dilemma. He said finding a way to motivate patients, utilize new technologies and convey how to effect these changes are essential. In addition, these results can inform public health policy as well as aid physicians and researchers in generating better screening for patients. – by Melissa Foster

For more information:

• Henry RR. Final results of the SHIELD study — Epidemiologic and public policy considerations from a five-year prospective diabetes mellitus study. Presented at: American Diabetes Association’s 71st Scientific Sessions; June 24-28, 2011; San Diego, Calif.

Disclosure: Dr. Bays is a board/advisory panel member of AstraZeneca and Merck and receives research support from Akros, Arena Pharmaceuticals, Cargill, Daiichi-Sankyo, Eli Lilly, Gilead Sciences, Merck, Novo Nordisk, Orexigen, Stratum, Takeda Pharmaceuticals and Vivus. Dr. Gavin is a board/advisory panel member for Abbott Diabetes Care, Amylin, Baxter, Daiichi-Sankyo. He is a consultant for AstraZeneca and Johnson & Johnson and on the speaker’s bureau for AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, Sanofi-Aventis. He also has stock or is a shareholder in Abbott Diabetes Care, Amylin and Baxter. Dr. Green is on the speaker’s bureau for AstraZeneca, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Merck, Sanofi-Aventis and Takeda Pharmaceuticals North America. Dr. Rodbard is a board/advisory panel member for Biodel and a consultant for Amylin, Biodel and Novo Nordisk. She has also received research support from Amylin, Biodel, MannKind Corporation, Novo Nordisk and Sanofi-Aventis. She is on the speaker’s bureau for Abbott Diabetes Care.

The content of the presentation was amazing. First, the fact that the researchers were able to monitor 200,000 people and get more than 70% of them to respond over 5 years was impressive. Data showed that the individuals knew a great deal [about diabetes], but were not able to implement the knowledge as effectively as they could have. That was, to me, the major point. What we have to do is figure out how to help them implement it. The knowledge is there, but the implementation is not effective. That is the bottom line.

- Robert R. Henry, MD
President
American Diabetes Association

Disclosure: Dr. Henry reports no relevant financial disclosures.

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