In a recent national survey of physicians, more than 90 percent of the country's primary care doctors could not correctly name the top three tests that a person with diabetes should have on a regular basis -- tests that could save their lives, experts say. More than 90 percent of American's with diabetes receive their medical care from primary care doctors, rather than diabetes specialists.
In the survey commissioned by Washington Hospital Center in Washington, D.C., one of the country's leading centers for diabetes treatment, nearly all of the physicians correctly named "hemoglobin A-1-c" as one of the most important tests for diabetic patients. However, only 24 percent mentioned cholesterol and just five percent named blood pressure These three tests have been identified by the National Diabetes Education Program as the most important in managing diabetes and reducing the risk of deadly complications.
"Diabetes is an epidemic in this country, affecting 16 million Americans," said Dr. Wm. James Howard, an endocrinologist and senior vice president and medical director for Washington Hospital Center. "We know that we can help these patients avoid serious complications with good diabetes management. This survey clearly shows that we need to more aggressively educate our physicians on the front lines of medicine. They must know how to effectively control diabetes to help their patients live as healthy and as long a life as possible."
Other survey findings underscored the overall lack of understanding in this country about diabetes and how to effectively manage this disease.
-- Despite the fact that most of the doctors could not name the top three test for diabetics, three-quarters of doctors said they are spending more time with diabetes patients than they did 10 years ago, and nearly all said they could treat the typical with diabetes without the help of a specialist.
-- Only one-quarter of the doctors surveyed (26.9 percent) knew the target blood pressure goal for people with diabetes, and only one-half (53.7 percent) correctly identified the goal for LDL (bad) cholesterol.
-- When asked how they refer to the all-important "hemoglobin A-1-c" test when talking with patients (the three-month marker for blood sugar control), physicians gave 30 different answers.
-- Only 17 percent of doctors correctly identified the upper limit for a normal fasting blood glucose.
-- One-third of respondents said they do not have adequate time to care for patients with diabetes. They attributed this to managed care pressures, and that diabetic patients have an extensive need for education and are often elderly.
The results of Washington Hospital Center's survey will serve as a guide for the hospital as it launches a three-year patient and physician education campaign, "Diabetes for Life."
"While the first step of this campaign was to conduct the physician survey, Washington Hospital Center recognizes the lack understanding about diabetes is broad based," said Dr. Howard. "Medical schools, hospitals, the federal government, researchers and the media also have significant roles to play in improving overall understanding of diabetes."
The survey results are all the more significant in light of the recent reports released by the Centers for Disease Control (CDC). According to an August 2000 CDC report, the incidence of diabetes increased 33 percent between 1990 and 1998. Just this past January, in a follow-up report, the CDC announced that this trend continued through 1999, with the incidence increasing another nine percent. The CDC study linked the increase in diabetes with a rising rate of obesity, a major risk factor for diabetes.
As the incidence of diabetes increases, experts are focusing on diabetes as much more than a disease of blood sugar, said Dr. Howard. More than 75 percent of people with diabetes die of heart disease, one of the major complications of diabetes. Other complications include stroke, kidney disease, and blindness. Studies show that by controlling blood sugar, blood pressure and cholesterol, patients have a much lower risk of developing these complications.
Washington Hospital Center commissioned Professional Research Consultants (PRC) in Omaha, Nebraska, to conduct this survey to help determine primary care physicians' level of knowledge about diabetes management. Between November 2000 and March 2001, PRC interviewed 203 primary care doctors -- internists, family practitioners and general practitioners -- from around the country. The Hospital Center diagnoses and treats more patients with diabetes than any other hospital in the Washington/Baltimore region. In addition, one-third of the patients treated at the Hospital Center for heart disease has diabetes.
A comprehensive package of information called "Diabetes for Life" kit is available to those who call 202-877-DOCS.
--- Washington Hospital Center is a 907-bed, not-for-profit, acute care teaching and research hospital based in Northwest Washington, D.C. It is the largest private hospital in the nation's capital and has the thirteenth highest patient volume in the United States. The Hospital Center is home to the nation's third largest cardiac program, a comprehensive Cancer Institute, a nationally recognized diabetes treatment program, a full range of women's services, MedSTAR, one of the nation's top shock-trauma centers; and extensive organ transplantation program, and the most advanced burn center in the region. Washington Hospital Center is a member of MedStar Health, a not-for-profit, community based health care organization comprised of 30 integrated businesses including seven major hospitals in the Baltimore/Washington area.