Primary care falls short on helping people with diabetes to help themselves

Physicians often neglect to counsel diabetic patients on how to self-manage their illness, suggest the results of a study.

"The important new message to primary care practices is that good diabetes management involves working with patients, not just sending them to the lab," said study author Russell E. Glasgow, PhD, of the AMC Cancer Research Center in Denver, CO.

Self-management counseling for type 2 diabetes -- a complex and challenging chronic illness requiring numerous lifestyle changes -- is recommended by the American Diabetes Association as part of their treatment and provider recognition program measures.

Such measures of delivery of important preventive services have become increasingly popular for treatment of chronic illnesses such as diabetes. Studies have shown that comprehensive disease management can reduce diabetes complications as well as deaths. Also, managed care organizations have recognized the high treatment costs of diabetes and want to increase quality of treatment, according to the study.

To examine how closely physicians adhered to diabetes treatment guidelines, the researchers surveyed a total of 435 type 2 diabetes patients, under the care of 47 physicians. They found that medical and laboratory test-related guidelines were more frequently followed than patient counseling-related guidelines. The study results appear in the July issue of the American Journal of Preventive Medicine.

Tests of blood pressure, lipids, and glycated hemoglobin (long-term blood sugar levels) were the most frequently reported recommended practices, while smoking cessation and nutrition counseling and self-management goal setting were the least. Only 3-5 percent of patients reported receiving all 11 of the provider recognition program recommended services, the researchers found.

"Given that most of the recommended prevention activities must be accomplished or initiated during the time-limited primary care visit, it is understandable that many of these activities are performed at substandard levels," said Glasgow.

Another finding was that patients who reported taking advantage of community resources to help manage their illness received the most medical and counseling-related services from their physicians. "The results suggest the importance of assisting patients to take advantage of their choice of community resources," said Glasgow.

While the frequency of blood pressure, lipid, and glycated hemoglobin testing was encouraging, more doctor-patient collaborative activities are needed, according to the researchers. "Such activities -- including setting mutually agreed-upon goals, incorporating the patients' social environment into the treatment plan, and problem-solving to overcome anticipated barriers -- characterize effective disease-management programs for diabetes," said Glasgow.

This research was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases.

The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the journal, contact the editorial office at (619) 594-7344.

Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org > (202) 387-2829.