When it comes to diabetes doctors failing to follow 'doctors orders'

Jun 12 2006

According to the latest reports when it comes to diabetes and following doctors orders, doctors are failing their patients.

The results of four completely independent studies presented at the American Diabetes Association's Annual Scientific meeting, indicate that doctors are failing to prescribe higher dose therapy in people with type 2 diabetes and high blood glucose levels or high blood pressure.

The findings imply that a lack of action on the part of doctors may be an important barrier to effective diabetes management.

One expert says that doctors appear to be unaware of the American Diabetes Association guidelines or else choose not to follow them.

It seems that in one group studied, the antihypertensive regimen was intensified in only 26 percent of visits in which the individuals had elevated blood pressure.

Other studies also identified a failure to increase treatment to maintain blood glucose levels at the recommended A1C goal of less than 7%. A1C is a blood test that measures blood glucose levels over a period of two to three months.

A U.S. study found that physicians delayed therapy intensification for those on oral anti-diabetic drugs on average until A1C was 8.5%.

Another study indicated that up to 75 percent of people with type 2 who were using insulin alone in the UK and Germany may have levels exceeding 7%.

The findings are of concern as some 20.8 million adults and children in the United States have diabetes which can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations.

Diabetes is the fifth leading cause of death by disease in the U.S.

Type 2 diabetes involves insulin resistance - the body's inability to properly use its own insulin and as a rule occurs in those who are over 45 and overweight, but it has increasingly been seen in obese children and teens in recent years.

A physician's age also affected the likelihood delivered and the younger the physician, it seems the greater the probability that medication would be intensified.

If an individual belongs to a minority group, the physician was about 10 percent more likely to intensify the antihypertensive regimen, likely due to the fact that non-Caucasians have a higher rate of complications arising from hypertension.

In a study of insulin therapy, which involves one or more insulin injections daily and patients are expected carry out a level of self-monitoring, researchers looked at data on adults with type 2 in Germany and the UK who were prescribed insulin and found similar proportions of patients were poorly controlled in both countries.

Experts believe more doctor education is needed with regard to achieving glycemic control and how to mix different types of insulin properly and/or how to teach patients to use such insulins and new devices.

One expert says many doctors are still locked into once a day insulin injections, an approach which does not give all patients good diabetes control.