Recent guidelines ignore newer oral diabetes agents like Avandia and Januvia.
Matthew Mintz criticizes this move, saying that this will lower the threshold for diabetes to begin insulin therapy.
He wonders if the endocrinologists, who authored the guidelines, have a financial motive to do so. Due to time constraints, primary care physicians do not have the inclination to manage insulin regimens, which can be complex and involving. In many cases, it is easer to consult a specialist to manage insulin-requiring diabetes. “Whereas endocrinologist see starting insulin therapy as common and easy,” says Dr. Mintz, “my perspective as a PCP is that patients do not want to take insulin and see it as an absolute last resort.”
Knowing this, what better way is there to generate revenue than to fundamentally alter the guidelines such that it will guarantee business to endocrinologists?
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- Primary care: "Just a few hours of instruction on diabetes, while they were in medical school"
- 5 diabetes posts you may have missed
- Avandia: Nissen tells endocrinologists to shove it
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{ 3 comments }
if one follows that line of thought, all doctors have financial incentive to keep their patients sick. in fact, it may make more sense to keep young patients sicker since they have better paying insurance and decades during which they can continue to pay. it’s only when your insurance becomes medicare that it starts to make sense to get patients healthy so they don’t clog up the physicians schedule.
hopefully that’s not what is being implied by bloggers.
Anonymous one:
You have concisely, and perhaps unintentionally, summarized the inherent conflict of interest in the sickness based medicine model (that includes physicians, hospitals, and pharmaceutical companies.) If the very question of conscious or unconscious incentives is met with moral indignation, then rational debate is precluded.
The few diabetics I have sent to endocrinology (because their diabetes proved very difficult to control, they had multiple endocrine issues or they seemed to have “type 1 1/2″ diabetes) have seen an NP who hasn’t provided any insight or changed management in any meaningful way.
As for the newer oral agents, studies show they lower A1C by 0.5 to 1 at best. For my uncontrolled diabetics, that’s simply not sufficient, so not including those agents in the guidelines seems appropriate.
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