Treatment of Type2 Diabetes

Overall Health Not Improving for Patients with Type 2 Diabetes

Despite dozens of medications and education resources for patients with type 2 diabetes, a recent study finds that overall patient health isn’t improving

Researchers from Massachusetts General Hospital found that only 23 percent of patients with diabetes had successfully improved their health.

Percentage hasn’t changed compared to similar research 15 years ago.

“In this study, we used the 2005-to-2016 nationally representative survey and examination data from the Centers for Disease Control and Prevention,” explained Pooyan Kazemian, the lead author of the research. 

“The treatment of diabetes is generally focused on meeting four targets: controlling blood sugar, blood pressure, cholesterol level, as well as promoting smoking cessation. Fewer than one in four American adults diagnosed with diabetes achieved the diabetes care targets recommended by the American Diabetes Association.”

Researchers also determined that within the diabetes population, young adults, women, and non-white patients were struggling the most to improve their health.

Are today’s best diabetes medications effective?

Metformin — one of the most prescribed drugs across the globe — was introduced in 1995, which would ideally mean that it began to have a significant impact on a patient’s ability to improve blood sugar levels, but Kazemian said that’s unfortunately not the case.

“These [drugs] are supposed to work really well, but our results show that these drugs have not reached the population at risk, and they have not been able to improve outcomes in the United States.”

Metformin is considered the first line of defense for a patient with diabetes who hasn’t seen improvements in their blood sugar through changes in diet and exercise. It’s considered an ideal treatment method because it doesn’t cause weight gain or hypoglycemia. And it’s one of the cheapest drugs on the market.

However, that doesn’t mean patients find it easy to take — and this isn’t being addressed properly.

Some patients stop taking Metformin due to side-effects

Another contributing factor to the lack of improvements in patient health could be patient adherence.

Earlier this year, research published in the journal Diabetes, Obesity, and Metabolism reported that despite being widely prescribed, a significant number of patients actually don’t take their metformin regularly because they are uncomfortable with its side-effects.

When paired with the little amount of diabetes education received by many patients with type 2 diabetes, it isn’t surprising that patients struggling with the side-effects don’t know there are other treatment options — like the “extended-release” form of metformin, or entirely different diabetes medications.

Without enough time to sit with a diabetes educator or diabetes specialist, many patients simply don’t know that there is an abundance of other treatment options.

People may hesitate to tell their healthcare team that they aren’t taking their prescribed metformin to avoid being scolded or referred to as a “non-compliant” patient. 

And then, when blood sugar levels aren’t improving, the question arises as to whether doctors are making changes in the patient’s treatment plan. 

Treatment plans aren’t intensifying when needed

A recent study funded by Sanofi-Aventis found that a significant number of patients with type 2 diabetes continued to present high HbA1c levels at appointments with their healthcare team, but their treatment plan isn’t being adjusted despite its obvious lack of efficacy.

Referred to as “clinical inertia,” shortfalls in treatment often result from too little time with diabetes specialists and inadequate healthcare coverage so that more expensive options beyond metformin are not affordable. 

“Clinical inertia prolongs the duration of patients’ hyperglycemia,” explains the report, “which subsequently puts them at increased risk of diabetes-associated complications and reduced life expectancy.” 

Some patients aren’t even being diagnosed…

One of Kazemian’s most startling discoveries was that many patients with high HbA1c levels aren’t actually being diagnosed with diabetes or treated. 

“We find that one out of four American adults with diabetes are not aware of the disease and so they are not receiving care,” she explained. 

The American Diabetes Association estimates that approximately 7 million people with qualifying HbA1c and blood sugar levels haven’t been diagnosed, but the number could be higher. 

More startling is the estimate that in addition to the 30 million Americans who have been diagnosed with type 2 diabetes, there’s also an estimated 84 million who are pre-diabetic.

Without adequate diabetes education and healthcare support, the likelihood is high that many of those patients’ blood sugar levels will rise to the status of type 2 diabetes.

The biggest problem is our health insurance system

“One of the main findings of this study was that insurance coverage turned out to be the strongest indicator for the achievement of diabetes treatment targets,” explained Kazemian. 

I believe by making health care more affordable and accessible, we can take an important step towards improving diabetes outcomes in the United States. 

The high drug costs in the United States are also a barrier to access to health care. And health care should also be efficient, and it should be personalized to patient needs.”

Kazemian believes that despite the tremendous amount of money and time that has gone into developing new medications for people with diabetes, too little effort has been put into making sure these treatment options are actually affordable and accessible.

“To be honest, I was surprised,” said Kazemian about the overall findings of her research.

I was expecting a better outcome considering that similar research in the early 2000s found that diabetes wellness did improve between the late 90s and early 2000s.

“So when I was conducting this analysis, I was kind of expecting that maybe things would have improved a little bit in the past 15 years. But, unfortunately, that was not the finding of this study.”

Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999, and fibromyalgia since 2014. She is the author of 4 books: Pregnancy with Type 1 Diabetes, Dealing with Diabetes Burnout, Emotional Eating with Diabetes, Your Diabetes Science Experiment. Ginger creates content regularly for Diabetes Strong, Healthline, HealthCentral, DiabetesDaily, EverydayHealth and her YouTube Channel. Her background includes a B.S. in Professional Writing, certifications in cognitive coaching, Ashtanga yoga, and personal training with several records in drug-free powerlifting. She lives in Vermont with two kiddos and two dogs.

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