Overview
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Primary care providers in the United States treat more than 75% of patients with diabetes.1 The Direct Observation Primary Care (DOPC) Study2 estimated that physicians in this setting spend an average of 11 minutes in face-to-face consultation with diabetes patients, approximately the same amount of time they are able to spend with patients who present to their offices with other illness or conditions. Many physicians feel that they are seeing more patients with diabetes than they were 5 years ago and seeing them more often.3 Despite the best of intentions, it is often challenging to meet American Diabetes Association (ADA) standards of care, in part because the time physicians can spend with individual patients is limited.
Further, in the traditional view of diabetes management, the physician is the driving force, and patients are expected simply to follow instructions as prescribed (see Table 1). In this model, the primary care physician is responsible for diagnosis, treatment, and outcomes.
Table 1. Traditional View of Diabetes Management4
Self-Management Guidelines
(for patient) |
Medical Treatment
(by physician) |
| 1) |
Follow lifestyle recommendations |
1) |
Prescribe diet and exercise |
| 2) |
Perform self-testing and recording |
2) |
Train the patient in monitoring disease |
| 3) |
Comply with therapy recommendations |
3) |
Use oral antihyperglycemic agents and insulin |
Over the past decade, however, research has suggested that a new approach to diabetes care is necessary to support improved patient involvement and promote compliance.
The new model of care supported by the National Institute on Diabetes and Digestive Kidney Diseases (NIDDK), the ADA, and the American Association of Diabetes Educators (AADE) promotes a more formalized patient education, specifically diabetes self-management training (DSMT). This model also recognizes that patients are in charge of managing their own care.5 If this empowerment approach is to be implemented successfully, patients have to be educated to make informed diabetes self-care decisions, and primary care physicians have to provide guidance in ways that support patients’ efforts.
