Influential Diabetes Experts Drs. Vivian Fonseca, Steven Edelman and Philip Raskin discuss current model of care amid "the most significant public health problem worldwide"
FRANKLIN LAKES, N.J., Nov. 2, 2011 /PRNewswire/ -- The current model for care of people with diabetes is no longer viable, and continuing today's approach could bring devastating consequences not only the United States healthcare system, but also emerging systems in developing countries, as diabetes is now the most significant public health problem worldwide.
On the crux of Diabetes Awareness Month, three of the world's most influential diabetes experts challenge a range of current views on diabetes in a new video series Medco Health Solutions, Inc. (NYSE: MHS) is calling "Critical Conversations: Diabetes" aimed at confronting some of the biggest, and most divisive issues in diabetes care today.
"We are at an important crossroads in diabetes care, and we must engage in an honest debate about the issues surrounding diabetes today if we are to ever have a chance at preventing the disease from exacting what can only be viewed as a catastrophic impact on global health," said Merri Pendergrass, M.D., Ph.D. National Practice Leader for the Medco Diabetes Therapeutic Resource Center® and host of "Critical Conversations: Diabetes" released today on www.DiabetesMonth.tv.
Joining Dr. Pendergrass in "Critical Conversations: Diabetes" are:
- Vivian Fonseca, M.D., FRCP, Tullis–Tulane Alumni Chair in Diabetes, Professor of Medicine, Chief, Section of Endocrinology, Tulane University; chairman of the clinical practice committee of the American Diabetes Association and editor in chief of Diabetes Care
- Philip Raskin, M.D., Clifton and Betsy Robinson Chair of Biomedical Research and Professor of Medicine in the Department of Internal Medicine at the University of Texas Southwestern Medical Center in Dallas; the editor of The Journal of Diabetes and its Complications; and Director of the University Diabetes Treatment Center and the Diabetes Clinic at Parkland Health and Hospital Systems
- Steven Edelman, M.D., professor of medicine in the Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego (UCSD) and the Veterans Affairs (VA) Healthcare System of San Diego and the director of the Diabetes Care Clinic, VA Medical Center; and founder of Taking Control of Your Diabetes.
These influential leaders in diabetes take on the current issues impacting diabetes care and the tens of millions of people living with the disease. A number of remarkable challenges to conventional wisdom rose to the surface during the series of interviews; challenges that have the potential to give rise to spirited debate among those organizations and individuals crafting policies and programs around diabetes care.
A Broken System
Drs. Fonseca and Edelman both challenged the current clinical care model, acknowledging that the system of one doctor and one patient and the traditional office visit paradigm is simply not viable. Both physicians instead advocate for an integrated system that includes a primary care manager supported by a range of specialists, and that enables use and reimbursement of emerging technologies to better address patient needs.
"There are not enough doctors going into primary care because of the challenges within the system and the fact that reimbursement is not as good, at least within the fee-for-service model, as doing procedures," said Dr. Fonseca. "Well, for a condition like diabetes, we don't want procedures. We want to prevent procedures."
Dr. Fonseca cites the use of telemedicine as an example of a new approach to care that must be accepted and acknowledged by insurers as a means to more efficiently engage patients.
"The concept of telemedicine hasn't really taken off because of the old model of payment where you only get paid if you see the patient," says Dr. Fonseca. "You're seeing the patient by a video screen, and talking to the patient by telephone. I think you should still be rewarded in some way."
Dr. Edelman cited the extreme wastage in the current system that manifests in time and financial resources: "We go through a whole laundry list of things [during visits with patients]and sometimes they're required for billing to get paid by insurance companies, but we waste a lot of time in those visits."
"People with diabetes should be able to eat anything they want"
A number of controversial issues were also raised, as each of the three physicians took stances that vary from commonly held views ranging from diet to weight management to complications from the disease, challenging many long-held beliefs.
Dr. Fonseca proposes an active role for government in diabetes prevention but cautions against intervention he believes would be inappropriate and counter-productive.
"The government shouldn't be telling an individual this is what your weight should be," says Dr. Fonseca. "They should provide the tools for people to get to the weight they want to be. What the government should be doing is providing the strategies for societal change and make it available. So, bike paths, exercise in schools, the government can easily do that."
Dr. Edelman takes aim at conventional wisdom on dietary management.
"People with diabetes should be able to eat anything they want," says Dr. Edelman. "We are not what we eat, we are how much we eat. It comes down to portion control and everything in moderation."
Dr. Raskin believes that all complications can be prevented, but that too many people don't do enough to address the issues.
"About 20 percent of people with diabetes when it's discovered, they already have some significant diabetic complication," says Dr. Raskin. "One of the things doctors should do when they make a diagnosis of type 2 diabetes is to screen that person for all complications."
Dr. Raskin also clarifies concept of gestational diabetes, a condition that affects about 18 percent of pregnancies according to the American Diabetes Association, and is believed to develop in expectant mothers during pregnancy.
"Gestational diabetes is a bad term," says Dr. Raskin, pointing out that many women diagnosed with gestational diabetes probably had diabetes before becoming pregnant.
For more on this and other critical diabetes topics, watch www.DiabetesMonth.tv.