Researchers examine why diabetes care falls short

The complexity of diabetes could require practice changes that include disease registries and focused models of care.

By Susan J. Landers, AMNews staff. Feb. 27, 2006.

Washington -- Several family physicians took a look at a major health issue with the intention of answering the question: Why is it that so many of the millions of patients with diabetes are either not diagnosed in the first place or are not able to control their disease well enough to prevent the myriad serious health problems that can follow?

The findings, published in the January/February Annals of Family Medicine, demonstrate that there is no easy answer.

The investigators were working independently, but all were driven by the desire to determine how quality care can be delivered to the nearly 21 million people in the nation who already have diabetes and how to be better prepared for perhaps 41 million more who could be diagnosed in the coming decades.

They found a few promising techniques. Among them were the establishment of disease registries for tracking patients, extra vigilance for symptoms of diabetes and the employment of new care models that focus on treating only diabetes to avoid the distractions of other health concerns.

The investigators all agreed that managing patients with diabetes is complicated. Blood sugars need controlling, as do blood pressures and LDL cholesterol levels. Even patients who received care from experienced physicians often fail to achieve all of the desired targets, said Stephen Spann, MD, chair of the Dept. of Family Medicine at Baylor College of Medicine in Houston.

Target A1c levels were reached for about 40% of the 822 patients in his study, Dr. Spann said. Blood pressure was controlled in 35%, and target cholesterol was reached in about 44%. But achieving all three targets occurred in only 7% of the patients.