In the last five years, the landscape of type 2 diabetes treatment has changed dramatically. Two new classes of drugs -- SGLT2 inhibitors and GLP-1 receptor agonists -- have been shown to prevent some of the most serious diabetes complications, including heart and kidney conditions, in patients. While primary care physicians treat the majority of patients with type 2 diabetes, many patients also seek out internal medicine specialists, including nephrologists, endocrinologists and cardiologists for care. To better understand the distribution of specialists in the U.S. who may be able to help care for the rising number of patients with diabetes, researchers from Brigham and Women's Hospital analyzed national data on the prevalence of diabetes and the number of internal medicine specialists in each U.S. state. They found that cardiologists were the highest represented specialists and conclude that they are well positioned to be integral members of a patient's care team. Their findings are published in JAMA Cardiology.
"While patients with diabetes traditionally seek care from endocrinologists and/or primary care physicians, these national data suggest that a broader network of clinicians, including cardiologists and nephrologists, may provide additional avenues for care delivery," said corresponding author Muthiah Vaduganathan, MD, MPH, a cardiologist at the Brigham. "This is especially important as the cardiovascular and renal risks associated with diabetes are becoming increasingly recognized, and as new strategies become available to modify disease course."
Vaduganathan and colleagues used 2016 data from the U.S. Centers for Disease Control and Prevention U.S. Diabetes Surveillance System to find the number of new diabetes cases in each state. They also gathered data on the number of practicing endocrinologists, cardiologists, and nephrologists in each U.S. state using 2016 Centers for Medicare and Medicaid Services physician and other supplier public files.
In 2016, 1.9 million U.S. adults were newly diagnosed with diabetes. Colorado had the lowest density of cases (6.2 percent) and Puerto Rico had the highest (13.7 percent). The density of specialists varied widely, but overall, cardiologists were the highest represented specialists and there was a lower ratio of patients with diabetes to cardiologists than to nephrologists or endocrinologists.
"For any patient seeing a specialist, it's important to ask how your diabetes may put you at risk and if there's anything that can be done to reduce risk," said lead author Ravi B. Patel, MD, a former internal medicine resident at the Brigham. Patel is now a clinical fellow in cardiovascular medicine at Northwestern University. "Diabetes is a systemic disease and should be treated as such, with many specialists as part of a team providing optimal care."
Patel is supported by National Heart, Lung, and Blood Institute T32 postdoctoral training grant T32HL069771.Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (National Institutes of Health [NIH]/National Center for Advancing Translational Sciences award UL 1TR002541); serves on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, and Boehringer Ingelheim; and participates on clinical end point committees for studies sponsored by Novartis and the NIH.
Paper cited: Patel, R et al. "Implications of Specialist Density for Diabetes Care in the United States" JAMA Cardiology DOI:10.1001/jamacardio.2019.3796