PMID- 24918800
OWN - NLM
STAT- MEDLINE
DCOM- 20140908
LR  - 20220318
IS  - 1941-9260 (Electronic)
IS  - 0032-5481 (Linking)
VI  - 126
IP  - 3
DP  - 2014 May
TI  - Health care provider management of patients with type 2 diabetes mellitus: 
      analysis of trends in attitudes and practices.
PG  - 145-60
LID - 10.3810/pgm.2014.05.2764 [doi]
AB  - OBJECTIVE: To identify attitudes and practices of endocrinologists (ENDOs), 
      family practitioners (FPs), internists (IMs), primary care nurse practitioners 
      (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail 
      pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 
      diabetes mellitus (T2DM) management; to compare current study data with results 
      from a similar 2011 study. METHODS: A nominal group technique focus group 
      identified barriers to optimal management of patients with T2DM. Five 
      case-vignette surveys were created, 1 for each group of health care professionals 
      (HCPs): ENDOs; FPs and IMs; NPs and PAs; CDEs; and R-PHs and H-PHs. Surveys were 
      tailored to each group. Versions were as similar as possible to each other and to 
      the 2011 surveys to facilitate comparisons. Questions assessed guideline 
      familiarity; knowledge of insulin formulations, glucagon-like peptide-1 (GLP-1) 
      receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors; patterns of 
      referral to ENDOs and CDEs; as well as cultural barriers and communication 
      barriers. Surveys were distributed by e-mail/fax to a nationally representative, 
      random sample of US HCPs during January and February 2013. RESULTS AND 
      CONCLUSIONS: Notable shifts from 2011 included NPs' increased familiarity with 
      American Diabetes Association (ADA) guidelines; FPs, IMs, NPs, and PAs continued 
      comfort with prescribing long-acting basal insulin but less with basal-bolus, 
      Neutral Protamine Hagedorn insulin alone, or human premixed insulin; increased 
      pharmacists' comfort in discussing long-acting basal insulin; increased 
      likelihood that FPs will refer patients with recurrent hypoglycemia unable to 
      achieve target glycated hemoglobin level to an ENDO; and continued incorporation 
      of insulin and incretins into treatment regimens. The trends suggest gaps in 
      perception, knowledge, and management practices to be addressed by education. 
      Most HCPs lack confidence in using insulin regimens more complex than long-acting 
      insulin alone. All providers need education on T2DM management guidelines, 
      differences between GLP-1 agonists and DPP-4 inhibitors, and how to intensify 
      therapy for patients not reaching goal blood glycemic level with use of multiple 
      agents. Pharmacists might benefit from education on glycemic treatment goals.
FAU - Williamson, Chad
AU  - Williamson C
AD  - CE Outcomes LLC, Birmingham, AL. chad.williamson@ceoutcomes.com.
FAU - Glauser, Terry Ann
AU  - Glauser TA
FAU - Burton, B Stephen
AU  - Burton BS
FAU - Schneider, Doron
AU  - Schneider D
FAU - Dubois, Anne Marie
AU  - Dubois AM
FAU - Patel, Daxa
AU  - Patel D
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Postgrad Med
JT  - Postgraduate medicine
JID - 0401147
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (GLP1R protein, human)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Incretins)
RN  - 0 (Insulins)
RN  - 0 (Receptors, Glucagon)
SB  - IM
MH  - *Attitude of Health Personnel
MH  - Clinical Competence
MH  - Communication Barriers
MH  - Diabetes Mellitus, Type 2/*drug therapy/therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/therapeutic use
MH  - *Disease Management
MH  - Female
MH  - Glucagon-Like Peptide-1 Receptor
MH  - Health Knowledge, Attitudes, Practice
MH  - Health Personnel/*statistics & numerical data
MH  - Humans
MH  - Incretins
MH  - Insulins/therapeutic use
MH  - Male
MH  - Practice Guidelines as Topic
MH  - Receptors, Glucagon/agonists
MH  - Referral and Consultation/statistics & numerical data
EDAT- 2014/06/12 06:00
MHDA- 2014/09/10 06:00
CRDT- 2014/06/12 06:00
PHST- 2014/06/12 06:00 [entrez]
PHST- 2014/06/12 06:00 [pubmed]
PHST- 2014/09/10 06:00 [medline]
AID - 10.3810/pgm.2014.05.2764 [doi]
PST - ppublish
SO  - Postgrad Med. 2014 May;126(3):145-60. doi: 10.3810/pgm.2014.05.2764.