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Preventing Clinical Inertia in Early Treatment Management of Type 2 Diabetes – Episode 4
Medical experts share considerations for early intervention in patients with diagnoses of diabetes.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE:How early do you start managing your patients with diabetes?
Jennifer B. Green, MD: I’m an endocrinologist, so I tend to see most [patients] with diabetes once they’re further along in the course of the disease. However, when it comes down to how early we should be intervening in type 2 diabetes, we really should be intervening before [patients receive a diagnosis of] type 2 diabetes, identifying [patients] with increased risk for progression to type 2 diabetes, and introducing interventions at that time to delay or potentially prevent progression to type 2 diabetes. But when a [patient receives a diagnosis of type 2 diabetes], they need to be treated immediately and not just for hyperglycemia. We need to start medical treatment as soon as they [receive a diagnosis] because it’s very clear that lifestyle modification or waiting for [patients] to fail nonmedical treatments [are] not an effective cure strategy. And they also need to be treated to address what we know is their increased cardiovascular risk. We’ve got to [manage] blood pressure and lipid [levels] aggressively and screen for complications immediately. If they do have, for example, kidney disease, we can intervene effectively to preserve kidney function.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Is that what you do? Even though you’re a specialist, the patient [comes] to you. The cardiologist sent a patient who [they] felt had high glucose [levels]. Maybe they [had] heart failure, maybe not. They sent the patient to you. The patient has high blood pressure, dyslipidemia, and hyperglycemia. What do you do at that point?
Jennifer B. Green, MD: All those conditions are my responsibility to address. One of the ways I can make it easier to intervene effectively in all those conditions is to look for interventions that provide synergy and can improve multiple risk factors or risk-related conditions at the same time. It is important to look for opportunities to integrate and unify our approach to risk reduction.
Eugene E. Wright Jr, MD: One of the things I’d like to pick up on [is] what Jaime said earlier: that all these systems are connected. What I’m learning now and what I’m encouraging my colleagues to do is when you see 1 condition, be it hypertension, hyperlipidemia, or diabetes, look for the others. They may be subclinical, under the radar, but when we look, we start to find these things. And as Jennifer said, that’s the opportunity to start to treat early.
Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE:As a primary care physician, do you manage them on all those aspects, or do you send them out? Who is the coordinator of care?
Eugene E. Wright Jr, MD: I’d like to respond a couple of ways to that. When we think about primary care clinicians, it’s not a monolithic group. You have those who are academic [and] those [who] are nonacademic. You have urban, you have rural, and you have nonphysicians, physicians, and practitioners. There’s not 1 answer. I like to see those patients early and start [treating] them aggressively with multidrug therapy to [manage] all the targets. But I realized I like to refer them to a certified diabetes care and education specialist. I realize that’s not always possible for many of my less resourced colleagues. Having an awareness that these conditions coexist and early detection and treatment matter [is] a key message.
Transcript edited for clarity.