Spotlight on diabetes knowledge and practice

Knowledge among U.S. patients and clinicians about recommended care for diabetes is good but could still use improvement, one can conclude from studies published this month.

The knowledge of clinicians was assessed by a survey of almost 1,000 endocrinologists, primary care physicians and non-physician providers conducted in 2011. According to the results, published in the Winter 2013 Clinical Diabetes, about 70% of endocrinologists and diabetes educators were very familiar with guidelines compared to about 40% of the other clinicians. The survey found several specific gaps in internists' and family physicians' knowledge, including management of insulin regimens other than long-acting basal analog. About half of surveyed primary care clinicians also fell short in their understanding of the differences between glucagonlike peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors. The authors called for clinician education to fill these gaps.

Among the general U.S. population, about 21% of non-diabetics and more than two-thirds of diabetics are very knowledgeable about the disease, according to their self-reports in a Harris Interactive/HealthDay poll. Most of the respondents knew the common risk factors and complications of diabetes, with the exception of stroke, which only 39% of the overall survey population and 56% of type 2 diabetics knew was a potential consequence of the disease. The survey also asked diabetic patients about how well they and their physicians control their diabetes and found that 35% reported it was only somewhat controlled and another 5% said “not at all.”

A more precise evaluation of U.S. patients' diabetes control was provided by National Health and Nutrition Examination Survey (NHANES) data published by Diabetes Care on Feb. 15. The data showed that 52.5% of people with diabetes achieved a hemoglobin A1c (HbA1c) level less than 7% in 2007-2010, compared to 44% in 1988-1994 and 57% in 2003-2006. The percentage with a blood pressure below 130/80 mm Hg was 51.1% in the most recent survey, 29% in 1999-2002 and 46% in 2003-2006. Control of cholesterol (low-density lipoprotein cholesterol level below 100 mg/dL) steadily improved from 36% to 46% to 56.2%. In the 2007-2010 data, 18.8% of diabetic patients achieved all three of these “ABC” goals, compared to 7% and 12% in earlier time periods.

The results show significant improvement in diabetes control but also room for more, the study authors concluded. “Access to care, education, and self-management support; personal knowledge, behavior, and adherence to therapy; healthy environments; as well as variation in the pathophysiology underlying diabetes all play important roles in achieving diabetes management goals that can improve long-term health of individuals with diabetes,” they wrote.