Experts call for early, integrated approach to avoid type 2 diabetes complications

In a new survey, physicians indicated a need for increased patient understanding of type 2 diabetes complications and early, integrated strategies that utilize multiple specialists to help prevent life-threatening complications.

The online survey, supported by Boehringer Ingelheim Pharmaceuticals and Sermo, queried 300 physicians (100 endocrinologists and 203 family medicine physicians). Their responses included:

83% of family medicine physicians said using a team of specialists during type 2 diabetes treatment can prevent serious complications, but 93% said their peers were not taking advantage of this approach.
Cardiovascular disease, diabetic neuropathy and nephropathy were the most commonly reported type 2 diabetes complications. Stroke, retinopathy and limb amputation were also listed as serious complications.
Lifestyle obstacles, particularly lack of motivation, failure to lose weight and nonadherence of medication regimens, were the most commonly reported reasons why patients with diabetes are unable to effectively control their disease.
71% of endocrinologists said they have a diabetes educator in their practice compared with 32% of family medicine physicians.
Half of respondents reported monitoring all type 2 diabetes complications equally.
32% of family medicine physicians refer patients to a nephrologist after detecting mild renal impairment compared with 12% of endocrinologists, who were more likely to wait until moderate renal impairment.

“We hope that these survey findings serve as a call to action for the type 2 diabetes treatment community,” Deborah S. Fillman, CDE, president of the American Association of Diabetes Educators and member of the survey steering committee, said in a press release.

I've taken part in many discussions about the prevalence of complications in the type 2 diabetes community and the use of an integrated team approach to help bring down these rates. Among other things, the survey of more than 300 practicing endocrinologists and family medicine physicians revealed that 83% of respondents believed that using a team of specialists early in the course of diabetes treatment can help prevent serious type 2 diabetes-related complications. However, 93% did not believe their peers were using this team approach.
I remain concerned that so many newly diagnosed patients are unaware of their risk for complications, especially renal impairment. Patients often associated 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 renal impairment.
I continue to advocate for this integrated team approach to both physicians and patients alike, and encourage us all to more readily acknowledge the rising rates of type 2 diabetes and the common, and potentially preventable, complications associated with the disease.

– Mark E. Williams, MD

Associate Professor of Medicine, Harvard Medical School,
Co-Director of Dialysis, Beth Israel Deaconess Medical Center,
Senior Staff Physician, Joslin Diabetes Center