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Self-management strategies needed for diabetics, say Pittsburgh researchers

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www.ProHealth.com • June 16, 2003


Primary care physicians hold key to helping patients avoid poor outcomes

NEW ORLEANS, June 15 – As the rate of diabetes in the United States continues to skyrocket, University of Pittsburgh researchers call for increased awareness among primary care physicians (PCPs) of the importance of patient self-management strategies such as proper nutrition and exercise, and of controlling patients' cardiovascular risk factors to avoid deadly complications. Three investigators report study findings at the American Diabetes Association's 63rd Scientific Sessions June 13-17 in New Orleans. PCPs need a clearer understanding of patient self-management

People with diabetes could have better outcomes and a better quality of life if they received more support from their PCPs regarding self-management – how to care for their diabetes – not simply a definition of what diabetes is, reports Linda Siminerio, R.N., Ph.D., director of the University of Pittsburgh Diabetes Institute.

Dr. Siminerio led a study to gain an understanding of PCPs' perceptions and their recognition of diabetes self-management education. In the assessment, she and her research team used two scales – the Barriers to Diabetes Care (BDC) and the Diabetes Attitude Scales (DAS) – to evaluate PCPs' perceptions.

Results from the BDC scale indicated that PCPs believe diabetes education and access are the greatest barriers to patients' diabetes care.

"Interestingly, those doctors who on the BDC reported the lack of education as the greatest barrier had the lowest mean scores on the psychosocial and autonomy areas on DAS, indicating a need for PCP education that includes attention to the psychosocial impact diabetes has on their patients and the important role of the patient in decision-making and self-care," Dr. Siminerio explained.

Self-management includes practices such as using glucose measurement results in making healthy decisions about meal planning and physical activity.

"It is important for PCPs to understand that diabetes education is not just a transfer of knowledge. It is instruction in how to care for oneself," Dr. Siminerio continued. "Diabetes education needs to expand out to communities and be more available through PCPs in their practice sites."

During the ADA conference, Dr. Siminerio will receive the Harold Rifkin Award for Distinguished International Service to Diabetes. The award recognizes her contributions to diabetes care worldwide as the American representative to the International Diabetes Federation (IDF). She works extensively with the North American Region of the IDF.

Underused: self-management education services and nutrition/exercise counseling

Despite evidence demonstrating that diabetes self-management education services have positive effects on patient outcomes, and that it is reimbursable, the service is underused by diabetic patients and their PCPs, reports Gretchen Piatt, a doctoral student in epidemiology at the University of Pittsburgh Graduate School of Public Health.

Researchers reviewed diabetic patients' medical charts at primary care offices in three geographically diverse communities. Average age was 64 years; 38 percent had educations beyond high school and 98 percent had insurance. Investigators looked for evidence of outpatient diabetes self-management training during the previous calendar year.

Results showed that less than 10 percent of all patients received this service. Rural patients in the study fared particularly poorly, with no self-management training.

"While the unavailability of trained diabetes educators in rural communities can explain in part the under-use of such preventive services, the low utilization of services in other communities may be due to the PCPs' failure to recognize how much their patients can benefit from diabetes education," said Piatt.

Better PCP monitoring of risk factors can avoid heart disease in those with diabetes

The University of Pittsburgh's Janice Zgibor, Ph.D., reports inadequate PCP monitoring and treatment of diabetic patients' heart disease risk factors. With better attention to their patients' non-diabetic conditions, PCPs can help them avoid heart disease, which remains the leading cause of death in people with diabetes.

Dr. Zgibor, who is a research associate in the department of epidemiology, University of Pittsburgh Graduate School of Public Health, examined the level of control of blood sugar, blood pressure and cholesterol in 762 patients at 11 primary care practices in 1999. Their average age was 65 years, and they had had diabetes for an average of nine years.

Results show that among patients with high cholesterol, those who already had heart disease were five times more likely to be treated for their high cholesterol than those without a heart disease diagnosis. Likewise, among patients with high blood pressure, those who already had heart disease were twice as likely to be treated for their high blood pressure than those without a heart disease diagnosis.

"Clearly, these results demonstrate poor primary prevention efforts through control of risk factors for heart disease in people with diabetes," said Dr. Zgibor. "Better efforts among PCPs at controlling risk factors could lessen illness and death from heart disease."



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