Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
A manuscript was recently published in the journal of the IDF, Diabetes Research and Clinical Practice, calling for a new approach to the management of type 2 diabetes. Please can you explain the reasoning behind this guidance?
One study suggested that 42 percent of people with type 2 diabetes who are treated for the disease do not reach their blood sugar goals, putting them at higher risk of organ and tissue damage, blindness and even death. We wanted to explore potential causes of clinical inertia among physicians and people with diabetes, which may lead to sub-optimal care.
The global Time 2 Do More in Diabetes™ survey revealed major disconnects in communication, disease awareness and expectations between patients and physicians. Our goal is to empower people with type 2 diabetes and physicians to effectively manage the disease.
What were the key recommendations made in this manuscript and how do these proposals differ from previous guidance?
The principal findings of the Time 2 Do More in Diabetes™ survey suggested that impairments in communication are at the heart of clinical inertia.
The white paper lays out four key principles that we believe are achievable in all environments and can improve the lives of people with diabetes and our guidance is unique, in that it encourages partnership between the two groups
- To improve health outcomes for people with diabetes, we need to improve communication between healthcare professionals and people with diabetes
- As part of this, healthcare professionals, carers, families and people with type 2 diabetes need to collaborate as a team to establish realistic goals
- Everyone is different. Time 2 Do More reinforced that we could improve care by taking into account individual needs of people with diabetes, not simply chasing glycemic, blood pressure, or lipid targets
- We call on purchasers and providers to incentivize good management in early disease in order to optimize quality of life for those people with diabetes
How important is it to implement simple steps to improve the management of type 2 diabetes? What can be done to make steps realistic and achievable?
It is important to be transparent and to take into account the individual needs of the person with type 2 diabetes.
By realistic goals we mean targets that are suitable for each person and take account of individual factors. This could include diet changes, exercise goals and treatment targets and also could involve integrating personal goals, i.e., weight, job worries etc., along with conventional targets.
We think people with type 2 diabetes should team with HCPs and caregivers, working to manage their diabetes. Involving family, caregivers is of course part of the solution too.
It was recently announced that diabetes killed five million people last year, yet a new survey, funded by Novartis, stated three quarters of people with type 2 diabetes are unconcerned about their risk of developing complications. What do you think is the reason for this?
In the Time 2 Do More in Diabetes™ survey we found there was a disconnection between what was being said by HCPs and what was being recalled by people with type 2 diabetes.
Health outcomes are a function of the communication between HCPs and people with diabetes. Therefore the relationship between HCPs and people with type 2 diabetes should be regarded as a partnership of equals and communication needs to be individualized to each person with type 2 diabetes.
Furthermore, people with type 2 diabetes need ongoing support and education long after diagnosis and each person with type 2 diabetes should take ownership and responsibility for the disease.
Should people with type 2 diabetes be more concerned about their risk of developing complications?
Every person with type 2 diabetes is different. If properly informed they can help to improve their health outcomes.
The survey also reported that physicians only expected half of patients to reach their blood sugar goals. Were you surprised by this finding?
I wasn’t frankly surprised that physicians expected that only half of their patients would reach their blood glucose goals. Physicians gave long experience of the struggle that many people with diabetes have in achieving target blood glucose. There are many factors that can adversely influence blood sugar levels, not least irregular eating (often for unforeseen reasons), stress, anxiety and depression.
Younger people face particular challenges in maintaining target blood glucose because of lifestyle, as can people with irregular work patterns. Achieving target blood glucose requires considerable effort and discipline, but it is important that physicians can, in a non-judgmental way, explain the importance of making every effort to improve blood glucose and offer the encouragement necessary.
How does the IDF plan to aid people with type 2 diabetes and physicians to improve management of the condition?
The mission of the International Diabetes Federation is to promote diabetes care, prevention and a cure worldwide. Our strategic goals are to:
- Drive change at all levels, from local to global, to prevent diabetes and increase access to essential medicines
- Develop and encourage best practice in diabetes policy, management and education
- Advance diabetes treatment, prevention and cure through scientific research
- Advance and protect the rights of people with diabetes, and combat discrimination
What are the main hurdles that need to be overcome?
We believe that HCPs have the best interests of people with type 2 diabetes at heart. What we need is more time. Managing type 2 diabetes early can be a part of setting realistic goals to prevent complications.
Where can readers find more information?
About Sir Michael Hirst
Sir Michael Hirst, from the United Kingdom, is the President of the International Diabetes Federation (IDF) 2013-2015.
He became interested in diabetes over twenty years ago when his youngest child was diagnosed with type 1 diabetes at a very young age. Then a Member of the British Parliament, Sir Michael championed the cause of diabetes in Parliament, as a result of which he was co-opted to the Board of Trustees of the British Diabetic Association, now Diabetes UK. There he served as a trustee in a variety of capacities for 17 years, most recently as the first non-medical Chairman of the Board of Trustees from 2001-2006. As Chairman, he oversaw major changes in the operations and governance of Diabetes UK, Europe's largest organisation for people with diabetes.
Sir Michael Hirst is a graduate in law of the University of Glasgow, and was an exchange student at the University of Iceland. He later qualified as a chartered accountant and became a partner in KPMG, the international accounting firm, until he entered the British Parliament. Sir Michael held a number of senior positions in frontline politics until 1997 and was knighted for political and public service in 1992. He has also served on the board of a number of leading charities and public bodies.