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BLOG: When have you last seen your PCP?
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Diabetes has been called the disease that will bankrupt Medicare. As the single most expensive disease we treat, it cost more than $100 billion last year in the U.S. alone and more than $800 billion worldwide.
Furthermore, diabetes is predicted to affect one in three children who are born after the year 2000. Similarly, the U.S. Surgeon General has declared that one in three U.S. adults is now overweight, and those patients at the highest risk for diabetes are often the least likely to access general care.
So, what is the single question that every eye care practitioner (ECP) should ask every patient?
“When is the last time you saw your primary care doctor?”
How many patients will answer, “It’s been many years,” and how many of those must be in the early stages of this deadly disease?
In eye care, we certainly play an important role in screening diabetes, too. The Diabetic Retinopathy Clinical Research Network’s Protocol AA study is examining the role of wide-field retinal imaging in early diagnosis of diabetic retinopathy, but even the earliest changes of diabetic retinopathy happen after significant microvascular damage has occurred in the kidneys, heart, nerves and brain.
Diagnosing diabetes early requires periodic blood sugar monitoring and measurement of other risk factors, including BMI and blood pressure — all in the wheelhouse of the primary care provider (PCP) and not the ECP. But how many of our patients even see a PCP? And how motivating can we be when we explain that blindness can best be prevented by early detection by a PCP?
A 2015 endocrinology study conducted at the University of Michigan (my alma mater) and Cambridge University showed that the early detection and treatment of diabetes led to a 30% reduction in cardiovascular events in the 10 years after diagnosis compared with patients diagnosed 6 years later. Furthermore, early diagnosis coupled with normal (nonaggressive) treatment of diabetes was superior to a 3-year delay in diagnosis, even when aggressive blood sugar control was used in delayed diagnosis patients. In other words, if the medical community is doing its job right, eye care practitioners should be the last doctors to diagnose diabetes.
ECPs surely need to look at the retina to screen for diabetes, but asking every “healthy” young patient to see a primary care doctor regularly might just save his or her life. Now isn’t that a question worth asking?