NN&I - May 2010
Diabetes Watch 32 Nephrology News & Issues May 2010www.nephronline.com Team approach to curb diabetes complications considered effective, but rarely usedStudy shows 83% of doctors like the idea, but only 7% currently use modelBy Thomas KeatingA recent survey of more than 300 doc-tors showed that 83% believed that using an integrated team of specialists to treat a newly diagnosed type 2 dia-betes patient will help prevent serious complications. But most doctors say they don't use such a team. "It's kind of a 'Do as I say, not as I do' finding," said Mark Williams, MD, clini-cal investigator and senior staff physi -cian for Joslin Diabetes Center, in an interview with NN&I. Williams helped develop the online survey, which was financially supported by Boehringer Ingelheim Pharmaceuticals, Inc. The results were released March 11. "Often times there is a team approach, but with some members missing," Williams said. "It's like (in basketball) when you have the center and the forwardbut no point guard." A team approach to diabetes care may include a family practitioner or an internist, a diabetes or endocri -nology specialist, andin the case of patients with renal diseasea kidney specialist with expertise in diabetes. Optometrists, podiatrists, cardiolo -gists, dietitians, and a diabetes educa- tor also may be sought out. Physicians surveyed identified car -diovascular disease, nerve pain, and kidney disease as the most common complications, with stroke, blindness, Insulin action and insulin resistance linked to same proteinBiologists have known for a long time that an enzyme called the PI 3-kinase is a crucial actor in the main molecular pathway for insu-lin signaling in cells. Researchers uncovered new evidence that one of the proteins in this enzyme also drives a pathway with an opposite result, triggering a stress response that leads to insulin resistance. Studies in cells and genetically modified mice show that the regu- latory subunit of the PI 3-kinase, a protein called p85, works both ways, said researchers at the Joslin Diabetes Center. Research was pub-lished March 28 in the journal Nature Medicine. Screening for diabetes is cost effective, study findsResearch now confirms that routine screening for type 2 diabetes not only helps prevent or delay illness, it is also highly cost effective, according to a study published March 30 in the British journal The Lancet .Using a detailed mathematical mo-del, the study concluded that early screening could greatly reduce dia-betes-related complications at a rea-sonable cost and substantially reduce mortality."This study confirmed for us what we have long believed to be true, but have never been able to show in clini-cal trials," said study author John Buse, MD, PhD, former president of Medicine and Science at the American Diabetes Association and one of the authors on the paper.The study employed a complex mathematical model known as Archimedes to simulate 325,000 people matching the U.S. population in catego-ries such as age, sex, as well as by health behaviors such as smoking, blood pres-sure levels, symptoms, medications, and numerous other factors. The simulated population under -went nine different screening strat -egies in sequence, ranging from no screening to screening beginning at age 30 and repeating every six months. The simulated patients were followed for 50 years by the study group or until they died. All the screening strategies reduced rates of heart attacks and diabetes-related complications (such as blind -ness, amputation, and kidney fail- ure) and most reduced death rates. Compared to no screening, most of the strategies were highly cost effective, meaning the cost was $10,000 or less per quality-adjusted life-year (QALY) added as a result of the intervention.and limb amputation as others. And of physicians surveyed, 44% said more than half of their patients with type 2 diabetes will develop at least one complication. Williams said that identifying how to create a usable integration model is difficult because doctors may avoid the team approach for various reasons. Geography and patient density can be major hurdles, he said. "Everyone has acknowledged that the current system doesn't facilitate integration easily," Williams said, "so we need to take the next step and swim in deeper in order to knock down barri -ers and come up with a plan." Diabetes_NNI0510_3.indd 32 4/16/10 10:31:01 AM
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