The Burden of Diabetes (Care)

Now that there is a plethora of clinical trial data with clinically meaningful end points proving that the burden of diabetes can be improved by a variety of interventions, including glycemic, blood pressure, and lipid control; the use of statins, ACE inhibitors, and aspirin; appropriately timed laser therapy for diabetic retinopathy; and screening of feet at high risk for neuropathic ulcers, it is now time to evaluate just how well we do with our current level of care. Over the past few years, there have been a variety of surveys indicating that despite our evidenced-based clinical trial data, diabetes care in the U.S. has been abysmal. Several of these reports have focused on levels of diabetes care comparing how providers of different specialties (and their patients) performed when compared with each other (1–4) in addition to the national standards. The ensuing discussions and controversies did not really address the major problem: all of the providers provided less-than-optimal care, and although there are many reasons for this, perhaps the most important one is the fact that our current systems of diabetes care make outstanding management for all difficult, if not impossible. Unfortunately, many providers confuse the “burden of diabetes,” which refers to diabetes-related morbidity and mortality issues, with the “burden of diabetes care.” This latter concept is all too prevalent for too many physicians. These patients are complex, often do not take the best care of themselves, require multiple medications, and, importantly, often require follow-up between visits. For a primary care provider who may be allowed 10 or, at the most, 15 min to see this patient (an impossible task even with twice as much time), seeing many of these patients is truly …