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Specialist and Generalist Care for Type 1 Diabetes Mellitus

Differential Impact on Processes and Outcomes

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Disease Management & Health Outcomes

Abstract

The incidence of diabetes mellitus (both type 1 and type 2) is growing to epidemic proportions, with an expected combined worldwide prevalence of 220 million by the year 2010. A subsequent increase in the incidence of diabetes complications is likely to follow if present trends continue, placing an increased burden on already troubled healthcare systems. While there are many identified biologic mechanisms for the development of diabetes complications, there has been little exploration of healthcare provider issues and their contribution to these outcomes. One area of research with few data is the influence of diabetes specialty care on outcomes in type 1 diabetic patients. Evidence demonstrates that both process delivery and outcomes are better in individuals with typel diabetes who are cared for by diabetes specialists compared with generalists. For example, those receiving care from diabetes specialists were more likely to receive diabetes education, to be treated with intensive insulin therapy (>2 injections/day), and to receive an eye examination compared with those receiving generalist care. Additionally, lower rates of proliferative retinopathy were observed in those receiving specialist care. Recent evidence also demonstrates that there are lower incidences of neuropathy, overt nephropathy, and coronary artery disease in those patients who spend a higher proportion of the duration of their diabetes in specialist care. Based on these observations, it is recommended that attempts be made to replicate the favorable characteristics of specialty care in the primary care setting. Healthcare systems should ensure the availability of access to diabetes specialists, as well as ancillary healthcare professionals including diabetes educators, with increased emphasis placed on coordinated care.

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Acknowledgments

The authors have no conflicts of interest directly relevant to the content of this review. Research findings reported in this article from the Epidemiology of Diabetes Complications Study were funded by the National Institutes of Health Grant DK-34818.

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Authors and Affiliations

  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Room 214 DLR Building, 3512 Fifth Avenue, Pittsburgh, Pennsylvania, PA 15213, USA

    Janice C. Zgibor (Research Associate) & Trevor J. Orchard

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  1. Janice C. Zgibor
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  2. Trevor J. Orchard
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Correspondence to Janice C. Zgibor.

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Zgibor, J.C., Orchard, T.J. Specialist and Generalist Care for Type 1 Diabetes Mellitus. Dis-Manage-Health-Outcomes 12, 229–238 (2004). https://doi.org/10.2165/00115677-200412040-00003

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