The Role of Primary Care Professionals in Managing Diabetes

Abstract

No one in the know doubts that most diabetes care is done by primary care providers. No more than 20% of people with diabetes ever see an endocrinologist, and there are not nearly enough endocrinologists to handle the ever-increasing number of people with diabetes. The vast majority of diabetes management is, and in my view should be, in the hands of generalists. This said, how are we all doing, and why should we worry about doing better? The sad fact is that health care providers—primary care and specialists alike—are not managing our patients with diabetes as well as we should be. Some data put the average hemoglobin A1c (A1C) of people with diabetes in the United States at 9%, which is clearly unacceptable. Diabetes remains an enormous contributor to cardiovascular disease, particularly among women, as well as the most common cause of working-age blindness and the most common cause of end-stage renal disease. Until the American health care system starts doing a whole lot better on diabetes care, no one can honestly say that diabetes is not a serious disease. No one can or should tell a …