Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
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Diabetes
Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
Discuss any aspect of type I or type II diabetes mellitus here
I never understood Diabetes as a surgical trainee and if a patient had Diabetes I could never work out what to do with their insulin. At the BMJ I was asked to look at Diabetes and whether there were
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Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
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Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
posted at 23/5/2012 11:46 AM BST
on bmj.com
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*Moderator*
Posts: 683
First: 17/11/2008 Last: 24/5/2013 |
I never understood Diabetes as a surgical trainee and if a patient had Diabetes I could never work out what to do with their insulin. At the BMJ I was asked to look at Diabetes and whether there were any evidence based tools or maybe a Diabetes journal we should be developing for Diabetes.And in the course of looking at this I couldn't help wondering that why, when there are fantastic evidence based guidelines out there are they not impelemented so that people with Diabetes get poor care? And today there is another Audit Report like many others before saying that even the nine standards of care the departemt of health asks doctors to do for patients with Diabetes eg checking feet, cholesterol, BP, eyes etc-= are not done in just under half of people. The BBC news report says The report said the NHS was spending at least £3.9bn a year on diabetes - three times more than ministers had estimated. But the watchdog said better management of patients could save £170m a year through fewer hospital admissions and less complex treatment. About 24,000 unnecessary deaths could be prevented too.More than 2.3m people are diagnosed as having diabetes. SO why is it so hard to implement Diabetes guidelines?http://www.nao.org.uk/publications/1213/adult_diabetes_services.aspx |
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Re: Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
posted at 23/5/2012 1:44 PM BST
on bmj.com
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Posts: 9
First: 22/5/2012 Last: 11/7/2012 |
Scary figures indeed! I do wonder though, and I don't have the patience to read the entire article, if patient compliance has been factored into this. Half the time, getting people into the GP surgery for their routine BP/bloods check is like trying to force a stubborn donkey into a car. |
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Re: Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
posted at 23/5/2012 2:05 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
It is not that the implementation of diabetes guidelines is difficult , but one should be accustomed to examine the diabetic patients routinely, & in a routine check up of diabetes all the protocols are not being followed up by every doctor. Actually the routine examination of a diabetic patient mainly involves clinical examination like careful examination of the feet to look for evidence of diabetic neuropathy, routine blood glucose & HbA1C levels to assess the control of diabetes, routine fundoscopic examination to see for diabetic retinopathy, urine routine to check for evidence of nephropathy, routine 12-lead ECG, & blood pressure monitoring etc. But most of the times it is the busy schedule of doctors which is the major reason why the guidelines are not properly implemented, however this should be regarded as negligence on part of the doctor. |
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Re: Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
posted at 23/5/2012 4:51 PM BST
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
Louisa, I have spent over 30 years studying this question. Poor treatment of any chronic disease that requires a great deal of self- care and patient education is a universal phenomenon. We have studied single payer systems such as in France, multipayer systems in Latin America and private systems in the US. All do the job poorly because the systems were built and the health professionals were trained to deal with acute illness that can be resolved by medications or operations. It's not that we do not know how to set up a system to provide excellent care for people with diabetes. All the elements are known and have been tested in clinical trials. First and foremost you need a team that consists of three types of professionals- a knowledgeable physician, generally a primary care physician, although some especially, young kids with type 1, may need a specialist or collaborative care; an educator who could be a nurse, dietitian, pharmacist, psychologist, even a teacher with diabetes training and a expert in diet. Around this core you might need to draw on others when the patient needs special care for complications both physical or psychological. Then you need a reimbursement system that provides the time to conduct the necessary care and education. What most systems have is 10-20 minute primary care visits, little or no educational programs and an impulse to blame the patient for not following an incredibly complex regimen. I would be happy to sit down with your health system leadership and set up such a system. I have done so in the US, Mexico and Argentina. As Demming so eloquently said decades ago: "any system is perfectly designed to achieve the results it achieves." |
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Re: Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
posted at 23/5/2012 5:19 PM BST
on bmj.com
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Posts: 1288
First: 9/12/2011 Last: 24/5/2013 |
Diabetes MD, I suspect Diabetes is more of a patient centered problem, Hence the less self care, the worse the disease gets. At some point the patient must take responsibiity for his care, and take his meds, Diet must be right etc. DuaneF |
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Re: Why are we so rubbish at treating Diabetes- The latest Audit Report is uncomfortable reading
posted at 23/5/2012 10:25 PM BST
on bmj.com
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Posts: 453
First: 29/4/2011 Last: 14/5/2013 |
I do not disagree with you on that point. The problem is that for,the most part we health professionals do not provide the education and skills necessary to do that. I am a charter member of the patient empowerment movement, but the systematic teaching of self-management skills remains a rare phenomenon in most health care systems. I have posted previously about the new joint EASD/ADA statement. It contains considerable information and references on patient empowerment. The DAWN study has considerable,information about the psychological barriors to self-care. See http://www.dawnyouth.com/documents/dawn%20materials/dawn_publications/10_psychosocial_problems_and_barriers.pdf |
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