Article: Americans need more help managing diabetes, experts say

A great article on managing diabetes from CNN.com:

WASHINGTON (Reuters) -- U.S. patients and doctors alike show a surprising level of ignorance about diabetes and are not doing nearly enough to manage the condition, diabetes experts said Wednesday.

A survey found that although patients believe they understand diabetes, they are not doing what they need to do to control it, and their doctors are unable to help much.

A team approach that would add nurses, diabetes educators and pharmacists to the mix might work better, they suggested.

"Diabetes prevalence has almost doubled since 1980 in America," Dr. Sethu Reddy of the Cleveland Clinic in Ohio and of the American Association of Clinical Endocrinologists told a news conference.

Nearly 21 million people in the United States have diabetes, according to the U.S. Centers for Disease Control and Prevention, with type 2 diabetes accounting for up to 95 percent of the cases. The CDC says an additional 41 million have pre-diabetes.

Type 2 diabetes develops as a result of diet, exercise and genetic components. Type 1, or juvenile diabetes, is an autoimmune disease in which the insulin-producing cells in the pancreas are destroyed by the body.

Type 2 diabetes can be prevented or managed with careful diet, regular exercise and in some cases with drugs.

Reddy and colleagues held a meeting they called the Diabetes Roundtable and agreed that for various reasons type 2 diabetes is not managed properly.

"We all agreed that the future of good diabetes care will not rely on a single doctor," he said. "Realistically, one doctor can't do everything for a patient."

Insurers, Medicare and other payers will often cover visits to a nurse or a diabetes educator, who can work more closely and personally with a patient, but patients need to know to ask for this care, and primary care doctors need to know to refer patients, Reddy said.

Not connecting the dots

The endocrinologists' group and the American Association of Diabetes Educators commissioned a Harris poll of 780 patients and more than 400 primary care physicians.

The findings suggest a "disconnect" between what patients know and what they actually do, said Donna Rice of the educators' association.

For instance, 69 percent of the patients said they felt knowledgeable about managing their condition. But 81 percent of the doctors said they were frustrated with the number of their type 2 diabetes patients who did not follow their treatment regimens.

Half of patients surveyed showed little or no understanding of their A1C level -- a measure of a protein that can indicate how well their blood sugar has been controlled for the past three months.

And 59 percent of patients admitted their diabetes was somewhat or not at all well-controlled.

"It's like knowledge doesn't equate to behavior change," said Rice, a registered nurse and wellness program manager at Botsford General Hospital in Novi, Michigan.

The doctors also showed they do not fully understand diabetes, according to the survey.

The majority of the primary care physicians surveyed -- 78 percent -- said insulin resistance is the most important contributor to progression of type 2 diabetes.

Yet the experts said the insulin-producing beta cells are progressively damaged in type 2 diabetes and that this process may be a more important factor than insulin resistance.

"This suggests that primary care physicians do not consistently focus on how beta cells in the pancreas work," Reddy said.

Diabetes is the sixth leading cause of death in the United States and patients have a high risk of heart disease, kidney disease, blindness and nerve damage.

Worldwide more than 194 million people have diabetes.