NEW INSIGHTS INTO DIABETES TREATMENT AND CARE

Controlling weight gain is a priority for patients with diabetes and their physicians. This includes getting enough exercise, eating right and taking medications that do not hinder weight control efforts. However, despite the priority that this plays in the diabetes management regimen, patients surveyed are not achieving success in maintaining a healthy weight because of difficulty in making healthy choices and obstacles posed by their medications in controlling their weight.

· Ninety-eight percent of patients said that diet and exercise are important to managing their diabetes (74 percent said “very important”, and 24 percent said “somewhat important”), yet only 15 percent claim they follow a prescribed diet plan “all or most of the time” and even fewer, 9 percent, said they exercise “all or most of the time.”

· Nine out of ten of physicians (91 percent) said getting their patients to commit to a regular diet and exercise plan is the biggest challenge they face in helping patients manage their diabetes.

o Sixty-eight percent of physicians and 60 percent of patients expressed dissatisfaction with insulin because it hampers their attempts to control their weight.

o Forty-six percent of physicians say that weight gain is the most common insulin side effect their patients complain about. The next most common is hypoglycemia (32 percent).

o Almost half of all physicians surveyed (47 percent) and more than half of the patients (53 percent) indicated that they are not satisfied with oral medications’ side effect of weight gain.

Patients’ communication with their physicians is critical in gaining control over their blood sugar levels. Patients need to understand the importance of an A1C level as a marker of their glucose and diabetes control over an extended period of time.

To be adequately informed, they need to be able to work with their providers to change their diabetes management plan as needed and adjust their medication and care to best suit their individual needs.

· Ninety-nine percent of the physicians surveyed said that they give their typical patient with type 2 diabetes a target A1C goal; however 37 percent of patients say that their physician has never told them what their A1C level should be.

· Physicians estimated that an average of 94 percent of their patients get an A1C test done on a regular basis (every three to six months); but only 79 percent of patients said that they had their A1C checked in the past six months.

· Forty percent of patients wish that their physicians or other healthcare providers would listen to them more often.

· According to patients, three very important elements of a successful diabetes plan are:

o Keeping diabetes-related complications to a minimum (86 percent);

o Keeping blood sugar at the level or range set by my doctor (80 percent); and

o Being able to continue in life with minimal disruptions (75 percent).

· More than 80 percent of physicians say that they bring up changing their patients’ diabetes management plan most of the time; however a little more than a third of patients (37 percent) say they have never discussed changing their diabetes plan with their physician or healthcare provider.

In addition to individual lifestyle choices and physician-patient communication, understanding medications and their respective side effects is a major factor in gaining control over diabetes. Both patients and physicians expressed interest and responsiveness to new therapies that can help patients primarily control their blood sugar, while not complicating their weight control efforts.

· Eighty-seven percent of physicians said that their patients were afraid of needles; however, only 36 percent of patients expressed a fear of needles.

· Ninety percent of patients surveyed take a prescription medication regularly to manage their diabetes (81 percent take oral medications and 25 percent take insulin – some patients take both orals and insulin to treat their diabetes).

· Eighty-eight percent of patients and 92 percent of physicians surveyed feel there is a need for better treatment options.

· Sixty percent of patients said they would be interested in trying new diabetes medications, while 62 percent of physicians said that they would prescribe new diabetes medications as soon as they became available.

· Eighty-six percent of patients surveyed want to improve their current medications because of side effects (52 percent), a need for better blood sugar control (48 percent) and weight gain (34 percent).

· Two primary reasons that physicians indicate they would change a patient’s medication regimen are incidence of hypoglycemia (85 percent) and weight gain (54 percent).

Survey Methodology

This survey polled more than 600 patients with diabetes and more than 400 primary care physicians (PCPs) in the United States. Harris Interactive weighted data from the patient survey to be representative of the total U.S. adult population age with diabetes on the basis of age within gender, education, household income, race/ethnicity, region, and propensity to be online. In theory, with probability samples of this size, one can say with 95 percent certainty that the overall results have a sampling error of plus or minus six percentage points of what they would be if the entire U.S. adult population aged 18 and over with diabetes had been polled with complete accuracy.

Data from the companion physician survey were weighted based on years in practice, gender and region, using targets for PCPs in general. Since 97 percent of the PCPs responding to this survey met the additional qualification of seeing at least one patient with type 2 diabetes per month, the population of PCPs interviewed for this study is considered to be quite similar to the general population of PCPs, and thus is weighted to targets for that group. In theory, with probability samples of this size, one can say with 95 percent certainty that the overall results have a sampling error of plus or minus six percentage points of what they would be if the entire U.S. population of PCPs had been polled with complete accuracy.

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DID YOU KNOW: Foot problems are an economic and social burden. The average cost for primary healing in the USA has been estimated to be between US$7,000 and US$10,000. The direct cost of an amputation associated with diabetes is estimated to be between US$30,000 and US$60,000. The estimated cost for three years of subsequent care ranges from US$43,000 to US$63,000 – mainly due to the increased need for home care and social services. The corresponding cost for individuals with primary care has been estimated to be just over US$16,000 to nearly US$27,000. In addition to these costs, there is a loss of quality of life, and a great emotional pain for the person with diabetes and his or her family. The estimated cost of the diabetic foot in the USA is some US$4 billion a year. However, through a care strategy that combines prevention, multi-disciplinary treatment of foot ulcers, close monitoring, and the education of people with diabetes and healthcare professionals, it is possible to reduce amputation rates by between 49% and 85%. See this week’s Item #1 and Item #4.

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