Health care provider management of patients with type 2 diabetes mellitus: analysis of trends in attitudes and practices.

OBJECTIVE: To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes mellitus (T2DM) management; to compare current study data with results from a similar 2011 study.
METHODS: A nominal group technique focus group identified barriers to optimal management of patients with T2DM. Five case-vignette surveys were created, 1 for each group of health care professionals (HCPs): ENDOs; FPs and IMs; NPs and PAs; CDEs; and R-PHs and H-PHs. Surveys were tailored to each group. Versions were as similar as possible to each other and to the 2011 surveys to facilitate comparisons. Questions assessed guideline familiarity; knowledge of insulin formulations, glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors; patterns of referral to ENDOs and CDEs; as well as cultural barriers and communication barriers. Surveys were distributed by e-mail/fax to a nationally representative, random sample of US HCPs during January and February 2013. RESULTS AND
CONCLUSIONS: Notable shifts from 2011 included NPs' increased familiarity with American Diabetes Association (ADA) guidelines; FPs, IMs, NPs, and PAs continued comfort with prescribing long-acting basal insulin but less with basal-bolus, Neutral Protamine Hagedorn insulin alone, or human premixed insulin; increased pharmacists' comfort in discussing long-acting basal insulin; increased likelihood that FPs will refer patients with recurrent hypoglycemia unable to achieve target glycated hemoglobin level to an ENDO; and continued incorporation of insulin and incretins into treatment regimens. The trends suggest gaps in perception, knowledge, and management practices to be addressed by education. Most HCPs lack confidence in using insulin regimens more complex than long-acting insulin alone. All providers need education on T2DM management guidelines, differences between GLP-1 agonists and DPP-4 inhibitors, and how to intensify therapy for patients not reaching goal blood glycemic level with use of multiple agents. Pharmacists might benefit from education on glycemic treatment goals.