SATURDAY, June 10, 2006 (HealthDay News) -- Doctors are failing to intensify treatment in people with type 2 diabetes who have high blood pressure or high blood sugar levels, according to four new reports.
These studies suggest that "clinical inertia" -- the failure of physicians to take action when they see abnormal findings -- is an important problem in managing diabetes effectively, the study authors contend.
The findings were to be presented Saturday at the American Diabetes Association's 66th annual scientific sessions, in Washington, D.C.
In the first study, researchers from Brigham and Women's Hospital, in Boston, collected data from nearly 11,000 outpatient records for 1,244 diabetics with high blood pressure who being treated by 166 physicians from 2000 to 2004. The researchers looked at the blood-pressure results and evidence of high blood pressure therapy intensification, and found that in only 26 percent of visits where elevated blood pressure was documented did patients receive intensified treatment.
"Clinical inertia continues to be prevalent in the managing of blood pressure in patients with diabetes," said lead researcher Dr. Alexander Turchin, associate physician in the division of endocrinology. "It has a significant impact on patients, and we need to continue to educate physicians about the importance of treating high blood pressure."
In the second study, researchers from Johns Hopkins University School of Medicine looked at 254 people with type 2 diabetes and high blood pressure who were part of a managed-care program for government employees and their dependents.
"There was a low rate of blood pressure medication intensification," said lead researcher Dr. Shari Bolen, a senior clinical fellow in internal medicine.
The review of medical records and pharmacy and claims data from 1999 to 2001 identified 1,374 visits by patients with uncontrolled blood pressure. Doctors intensified blood-pressure treatment in only 12 percent of the visits, the researchers found.
Patients were more likely to have their treatment intensified if they saw their regular doctor, Bolen said. "There is a communication issue," she said. "Patients might do better if they have a care coordinator."
The third study looked at the prescribing of oral anti-diabetic drugs. The findings were based on an analysis of pharmacy and lab claims by a commercial, preferred-provider organization model of a national managed-care group.
To identify a study group, the researchers collected data on 9,416 people who had received a first prescription of an oral anti-diabetic drug between January 2001 and April 2004. The researchers then looked at the results of A1c tests, which measure blood glucose levels.
At the time patients started on anti-diabetic drugs, just 33 percent of the patients were at or below the American Diabetes Association's A1c goal of less than 7 percent.
"Unfortunately, 67 percent were well above the goal," lead researcher Craig A. Plauschinat, an outcomes research manager at Novartis Pharmaceuticals Corp., said in a prepared statement.
It took an average of 240 days before a doctor added another oral anti-diabetic drug. By that time, 67 percent of the patients had A1c levels approaching 10 percent, Plauschinat said.
"Interventions assisting patients and physicians to recognize and overcome clinical inertia represent a specific opportunity to improve glycemic control in type 2 diabetes," Plauschinat said.
In the last study, researchers looked at patients who were taking insulin injections to control their diabetes.
"Overall, the average A1c for 3,658 individuals was 8.4 percent," lead author Dr. Stephen Gough, a professor of medicine at the Institute of Biomedical Research at the Medical School of the University of Birmingham, England, said in a prepared statement. However, about one-third had A1c levels at or above 9 percent, and 18.2 percent had A1cs at or above 10 percent, the researchers found.
"If this sample is representative, which we believe it is, glycemic control may be suboptimal for up to three-quarters of the people using insulin alone to control type 2 diabetes," Gough said. "Identifying and overcoming obstacles that prevent optimal insulin therapy, including adequate intensification when needed, is essential if the gap between recommended glycemic targets and control is to be closed."
One expert thinks the failure of some doctors to apply what they know needs to be addressed to improve patient care.
"There are generally two great challenges in medical practice -- dealing with what we don't know, and applying what we do," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine. "These presentations at the American Diabetes Association conference collectively indicate that failure to apply what we know is limiting the quality of care diabetic patients are receiving."
Innovations in medical practice and education can fix many of these problems. Katz said. "Failures in medical care related to what we don't yet know are regrettable enough," he said. "But failures to promote health or prevent dire complications that result from not using what we already have at our disposal are especially tragic."
More information
The American Diabetes Association can tell you more about diabetes.
