Significant Finding #1: “… improved control of glycaemia, lipids, and BP in patients with type 2 diabetes when compared with previous studies… “[Location: Catalonia, Spain; Setting: Primary Care] (Vinagre I, 2012)
Significant Finding #2: “… a primary care setting where regular monitoring of glycemic control is done, where patients concerns and fears about diabetes are addressed, where patients are educated about diabetes, diet and exercise and advised on compliance with medication leads to improved glycemic control… “… ” [Location: Tobago and Trinidad, West Indies; Setting: Diabetes Primary Care Clinic] (Babwah T., 2011)
As diabetes cases surge globally, estimates point at a one in ten incidence rate of diabetic adults in North America alone (International Diabetes Federation). While diabetes is attributed to a number of causes including genetic and environmental risk factors, proper diabetes management seems to be influenced not just by medication, lifestyle and diet interventions but also the nature of relationship between patients and their physicians.
The PCP is the first contact point in the patient-physician relationship with respect to any medical condition, including diabetes. However, primary care physician shortage seems to create increasing pressure on the current physician pool. In conditions requiring detailed assessment of medical history and symptoms, this lack of attention and care at the primary level can spell the difference between success and failure in the realm of diabetes management.
Two recent inspiring cases have highlighted the role of the primary care setting in better diabetes management. The first one (Vinagre I, 2012) is a recent cross-sectional study that was carried out in Catalonia, Spain across primary health care centers. A huge population of 3,755,038 individuals between the ages 31 and 90 years was involved to identify 286,791 Type II diabetes patients. Diabetes management involved lifestyle changes, anti-diabetic drugs and insulin therapy. The study indicated encouraging results regarding improved glycemic control, and favorable results related to lipids and blood pressure in the study population. The role of early detection of the chronic condition, appropriate treatment by primary care professionals, and a “target-based management system” which was driven by financial incentives was highlighted by researchers.
The other study was about a three year long quality-improvement project at a Trinidad (West Indies) health center (Babwah T., 2011). The study included diabetic and diabetic hypertensive patients at a special diabetes clinic managed by a registered nurse and a PCP. Diabetics were not only monitored for their glycaemia, but also got a chance to discuss their concerns and fears regarding the complex disease accompanied by a number of co-morbidities. Education about disease manifestation, nutrition, exercise and physical activity and the importance of compliance to prescribed medication were essential objectives of the quality program. Unsurprisingly, superior glycemic control at the end of the three year period and the need for establishing such low-cost primary care clinics was identified.
In an era where more and more medical students choose to get into a specialized medical role, the significance of a primary care practitioner seems to have receded into the background. However, in order to achieve result oriented outcomes in chronic diabetes management, the human side of medicine, more so the primary care practitioner has a significant role to play in the long run.