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Negative provider attitudes toward diabetes and its management may be barriers to better care for diabetic adults

Primary care providers (PCPs) often do not follow recommended standards for diabetes care. Their own negative attitudes toward the disease and its management, as well as a perceived lack of support from society and the health care system for their efforts to control diabetes, may be barriers to better care for patients with adult-onset diabetes.

Providers agree that the treatment of hyperglycemia (high blood sugar) is effective in preventing the complications of diabetes—such as kidney disease and blindness—and that their treatment and advice improve patient outcomes. However, when Anne C. Larme, Ph.D., and Jacqueline A. Pugh, M.D., of the MEDTEP Research Center on Minority Populations at the University of Texas Health Science Center, San Antonio, interviewed 31 PCPs, the physicians revealed doubts about the efficacy of diabetes treatment and their ability to carry it out.

In a study supported in part by the Agency for Health Care Policy and Research (HS07397), the researchers asked the PCPs attending an eight-session continuing medical education (CME) program how they rated on a 10-point scale the treatment of diabetes compared with the treatment of five other chronic conditions. Most PCPs felt that diabetes was significantly harder to treat than hypertension and angina, and a majority rated hyperlipidemia and arthritis as easier to treat than diabetes. Most PCPs felt that diabetic medications were more difficult to regulate than those for other chronic conditions because patient response to the medication fluctuates, and the drugs sometimes increase rather than decrease symptoms.

Also, management of the disease relies on changes in diet and exercise, which lie outside of provider control. Finally, the extra time and expense required for diabetes care is not supported by clinic administrators. CME programs can more effectively promote adherence to standards of diabetes care by not only updating provider knowledge but also by addressing the emotional dimensions of care. Also, providers need to shift from an acute to a chronic model of care and from the role of primary decisionmaker to that of teacher and facilitator, conclude the researchers.

More details are in "Attitudes of primary care providers toward diabetes," by Drs. Larme and Pugh, in Diabetes Care 21(9), pp. 1391-1396, 1998.

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