Individual therapy for type 2 diabetes is now widely recommended. However, if one looks at the extent to which patients’ personal circumstances are discussed in doctor-patient conversations, deficits are apparent, as a survey of physicians and diabetic patients revealed.
In the recently published statement of the American and European Diabetes Associations ADA and EASD, a recommendation is made for individualized therapy in type 2 diabetes [1]. But only if a therapy takes into account a patient’s life circumstances and specifics is it individual. So what do physicians discuss with their patients during the initial consultation and routine check-ups?
Online survey in eight countries
To obtain information on this, an online survey was launched in eight countries, including Germany, the United Kingdom and Saudi Arabia, as part of the “Living Diabetes: Journey for Control” program initiated by MSD. It took place from the end of June to mid-August 2012. A total of 807 interviews were conducted with diabetology and endocrinology clinicians and primary care physicians, as well as 899 adults with type 2 diabetes treated with oral antidiabetic drugs. Khalid Al-Rubeaan, MD, from Riyadh, Saudi Arabia, presented the results from a physician’s perspective at the EASD annual meeting in Berlin. “First of all, we are very happy to see that, at about 95%, almost all physicians are aware of the importance of a patient’s physical activity and dietary habits for diabetes management,” Dr. Al-Rubeaan said. The importance of blood pressure and lipid control is also mostly clear, he said. However, it’s a different story when it comes to occupational activities and cultural factors, he said. The topic of “diabetes management during fasting periods” is addressed too rarely by physicians in some countries. Rather unfavorably the results turned out e.g. in Germany: Almost 70% of physicians stated that they did not address their patients about religious fasting, or only sometimes. Since the therapy is often not adjusted, many patients have lost blood sugar control after the fasting period or come with complications, Dr. Al-Rubeaan regretted. He drew attention to the fact that fasting periods are also practiced outside Islam, and that data on therapy recommendations for these periods vary widely internationally. Dr. Al-Rubeaan advocated modified medication and the use of protocols with rules for fasting periods, especially to avoid hypoglycemia.
Patients want more info on hypoglycemias
Other important results of the survey from the patient’s point of view were presented by Dr. Rosario Arechavaleta, Guadelajara/Mexico: 53% of patients said they had experienced hypoglycemic symptoms at least once, but only 37% said they had raised the issue in a routine conversation with their physician. In 44% of the cases, the hypoglycemias had occurred during their working hours. However, 76% had never talked to their doctor about their working conditions. 31% also said their doctor never mentioned how they could reduce their risk of hypoglycemia.
Dr. Arechavaleta derived the following conclusions: It is necessary to make therapy more individualized. Physicians and patients would need to discuss all important life circumstances that could affect blood glucose management. Medication options are not always discussed with patients and many would like more information including prevention of hypoglycemia.
To help patients, there is a lifestyle checklist with all the information that should be brought up with the doctor. It can be requested via the MSD company.
Sarah L. Pampel
Literature:
- Inzucchi SE, Bergenstal RM, Buse JB, et al: Diabetes Care 2012; 35(6): 1364-1379.
Source: Press briefing on October 3, 2012 at the EASD Congress in Berlin, organizer: MSD
