Primary care: "Just a few hours of instruction on diabetes, while they were in medical school"

So says the misinformed NY Times. Trust me, I have had many more than a “few hours” of training in diabetes. It is poorly-researched articles like these that push patients towards unnecessary specialist care.

There should be no reason why most cases of diabetes cannot be treated appropriately in a primary care setting – without a referral to an endocrinologist. (via Medpundit)

Comments

Anonymous
I think the problem with primary care handling diabetes has nothing to do with how much time they spend in med school on diabetes, but rather how much they can stay up to date. While some endocrinologists are dedicated just to diabetes, primary care doctors have to deal with literally everything. Also, endocrinologists very often have the benefit of having in house CDEs, nutritionists, and podiatrists. Some GPs are afraid of insulin, not using it till a1cs are at 8% on 3 OAs, and even then referring to an endocrinologist to start it. Some GPs have way too lose of standards, considering a1cs of 7% (which translates to an average glucose around 170) normal in people not known to have diabetes. An a1c of 7 may be a target for people who already have diabetes, but certainly doesn’t represent normal blood sugars.
I’m not saying that everyone needs an endocrinologist. Clearly there aren’t enough for everyone with diabetes to see one, but regardless of how much time is spent in med school on diabetes, it’s continually evolving and primary care is sometimes spread too thin as it is.
RJS
Trust me, I have had many more than a “few hours” of training in diabetes. It is poorly-researched articles like these that push patients towards unnecessary specialist care.
Right on. Pharmacists, too, for that matter.
I think the problem with primary care handling diabetes has nothing to do with how much time they spend in med school on diabetes, but rather how much they can stay up to date.
Possibly, but again, I doubt it. I suspect punting to an endocrinologist or clinical pharmacist — which happens more than you think — is more a matter of time than anything else. Diabetes and its related comorbidities takes TIME to manage. And we all know how short most PCPs are on that…
That said, I’ve seen some pretty freakin’ wacky drug regimens for handling T2DM. And most of these patients were pretty unhappy with the way it was being managed.
As always, a one-size-fits-all retort to the idea that PCPs “can’t do” diabetes doesn’t work. It’s always a blending of factors. Sometimes ignorance, sometimes time, sometimes apathy.
I like to think of it as a Venn diagram of factors when there is a problem. (And usually there is not a problem.)
Anonymous
My wife has T2DM and does very well under the care of a family doc. Her care has not been guideline compliant in serveral respects, but they have a good relationship, and she has worked hard to comply with the care, losing 40 pounds and achieving essentially normal metabolic parameters and off almost all meds now. Don’t ever discount the value of the doctor patient relationship in primary care.
Anonymous
HgcA1c of 7 is equal to an average blood sugar level of 150 not 170.
Anonymous
RJS:
The vast majority of patient’s I’ve seen (and I’ve been around a long time) with DM involving management by a clinical pharmacist were actually VA’s pt’s with the “PCP” being an NP. Hardly a fair comparison. Diabetes is bread and butter internal medicine unless there are sequalae/control issues. The author of the article is an idiot if she thinks your typical internist has a “couple hours” of DM education. Of course, her editor is as stupid as she is for letting this drivel get published, and now americans who read the times think the same idiocy.
Anonymous
Anon 6:40
This is the calculator I used:
http://www.obfocus.com/calculators/HemoglobinA1C.htm
Most home meters are plasma calibrated, therefore it makes more sense to use the plasma result.
http://hallofrecord.blogspot.com Bruce Hall
Diabetes prevention seems a bit under-represented in family practice. The group to which my wife and I go failed to
recognize early signs in m wife’s bloodwork. Her problem was discovered by Dr. Edward Lichten of Birmingham, MI who provides some other specialized care.
My wife was fortunate enough to get an early warning and has reduced her weight by 35 lbs., her trigiycerides to a very low level and her blood sugar to around 70 by strictly following the approach of Dr. Michael Eades. Our family doctor still refuses to believe it’s efficacy because it doesn’t conform to accepted medical thinking… despite the evidence staring him in the face.
Must have been something else.

Primary care: "Just a few hours of instruction on diabetes, while they were in medical school"

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