Type 2 Diabetes: The Huge Disconnect Between Evidence and Performance
Doing the Same Thing and Expecting a Different Result
Optimal medical treatment (OMT) for type 2 diabetes produces truly stunning results. OMT is defined as concurrently achieving a hemoglobin A1c of 7 or less, a blood pressure of 140/90 or less, and a non-HDL cholesterol of 130 or less. Here is the latest assessment from the New England Journal of Medicine on how well we do with achieving these goals. Only 22% of Americans with type 2 diabetes achieve these goals concurrently. OMT also includes not smoking and taking aspirin for higher risk individuals with diabetes. Twenty-two percent of diabetics are smokers which knocks OMT achievement down to about 18%. Despite the proven benefit of achieving these goals, our medical system performance in achieving them is miserable and getting worse. The benchmark for achieving OMT in diabetes is 55%. These failures have real consequences. More Americans are having heart attacks, strokes, losing their vision, and having amputations because our system has failed to make the adjustments required to deliver OMT more consistently to our diabetic population.
Only 51% of patients with diabetes achieve their sugar goal despite all the new medications and glucose monitoring equipment introduced in the past several years. Only 70% have their pressure controlled. Just over half have their cholesterol controlled—and all the numbers are getting worse! Minnesota measures optimal medical treatment for multiple chronic conditions. They perform much better than the national average, but even there huge performance variation exists. Group production of OMT varies from 16% to 57%. I have seen individual performance of as high as 65%. The Steno 2 studies proved that achieving OMT is highly protective. It makes a big difference in outcomes.
I have worked with doctors and nurses all my life. I know they want to bring the best medicine to their patients, and they work hard in a broken system to give patients the best that they have. It is not the professionals who are broken, it is the system and leadership. Every day we hear institutions brag about their excellent, patient-centered care. The data does not lie. There is still huge variation in diabetes management, and it is getting worse. It will not get better until we systematically develop primary care teams designed to produce optimal medical treatment in diabetes. I have never seen OMT rates that exceed 50% in organizations that don’t effectively use best practice protocols and population health tools. Success requires new science, new systems, and new payment models. Until we incorporate those components, too many Americans will lose their legs and vision. In the meantime, bragging about excellent, patient-centered care just doesn’t ring true!
The entire diabetic industry is built on selling insulin and other drugs. Fasting effectively without these pharmaceuticals reverses type II diabetes in most cases. Unfortunately, the industry hates that notion completely. These Facts are things these people sometimes can’t accept...
Dr. Jason Fung has helped thousands of patients to not only loose weight but also reverse their type ii diabetes in parallel!