I and seventy regional physicians sat in a meeting room last month and learnt just how badly our healthcare services are failing type 2 diabetic patients.
Early data from an international review of diabetes management shows the much-feted educational campaigns blaring across the region are clearly making little to no impact on the people that matter.
Some choice picks include the revelation that more than two-thirds of diabetic patients in the Middle East are not hitting the glucose goals they should be.
We soar past the internationally recommended A1C of 7% and instead, average out at a complications-inducing 8.1%. We’re lapse on A1C testing.
Most patients notch up a mere one check a year. Comfortingly, diabetics themselves appear equally as incompetent, with the majority managing a mere three to five blood checks a week, rather than the suggested three a day.
But, to give them the benefit of the doubt, that could be because no one has told them to (apparently only 21% have seen a diabetes educator, ever, since diagnosis). All in all, it’s a less than rosy picture.
It looks bad for physicians. One of the more damning findings was that, when asked to hazard a guess at the percentage of patients on target with their glucose control, the doctors polled opted for an optimistic 42.
The actual number was 28%. (To be fair, the majority of these doctors apparently aren’t running A1C tests, so how would they know?)
But the blame game is complicated. Not least because every endocrinologist – UAE-based anyway – told me of their frustration with a healthcare system that bogs down its specialists with patients that could be better handled in primary care.
Apparently the mere suggestion of a raised blood sugar level is enough to see a patient packed off gleefully to tertiary care, because clinical guidelines prohibit primary care doctors from managing type 2 diabetics past the “Have you thought about losing weight?” stage.
And referrals are apparently a one-way deal, meaning that many specialists – rather than handling patients who genuinely need their expertise; are instead spending their time tweaking diet sheets. (Which leads me on to another issue – our shortage of community-based dieticians.)
The study figures are startling, but so are the issues that are causing them. For me, the results are less a diatribe on diabetes and more a reminder that above all, we are lacking a comprehensive primary healthcare service, manned by primary care physicians.
Without these front-line doctors – trained, prepped and authorised to head up disease management – we’ll never make a dent in diabetes, because there will never be enough specialists. In the UAE alone, one in five people aged between 20 to 79 has diabetes. We have less than 150 endocrinologists.
It doesn’t take a study investigator to work out the gap.
Joanne Bladd is the editor of Medical Times.
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