Type 2 diabetes care and insulin intensification: is a more multidisciplinary approach needed? Results from the MODIFY survey

Robert M Cuddihy, Athena Philis-Tsimikas, A Nazeri
Diabetes Educator 2011, 37 (1): 111-23

PURPOSE: The purpose of this study was to investigate the opinions of primary care physicians (PCPs) and diabetes specialists on their perceived role in tackling type 2 diabetes (T2D) and the challenges they face, particularly regarding insulin intensification.

METHODS: Six hundred physicians from Germany, Japan, Spain, Turkey, the United Kingdom, and the United States were recruited to complete an online survey. Screening criteria included T2D patients seen per week (Europe/Japan: all ≥ 2; United States: PCPs ≥ 5; specialists ≥ 10) and years in practice (3-30 years).

RESULTS: Most physicians had seen an increase in TD2 patients in the past 5 years, and almost all agreed that the burden of diabetes is increasing. Notable proportions of PCPs never initiate/modify insulin and never/rarely intensify insulin. Main barriers to insulin intensification cited were lack of experience and lack of time to educate patients. Better collaboration between primary and secondary care was considered one of the most important factors in improving insulin treatment of T2D.

CONCLUSIONS: PCPs are less involved in the initiation and intensification of insulin than specialists; however, all physicians appreciate the need for increased PCP involvement. A multidisciplinary approach that includes using the skills of diabetes educators will assist physicians in improving management of T2D.

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