Global Survey Reinforces Need For Individualized Approach to Type 2 Diabetes Management

Almost two-thirds (63%) of physicians surveyed agree that a patient's lifestyle influences blood sugar control,1 yet some lifestyle factors not routinely discussed1

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BERLIN, Oct. 3, 2012 /CNW/ - New data from a global survey of physicians and type 2 diabetes patients reinforce the need for an individualized approach to management of type 2 diabetes. In addition, the survey revealed that not all lifestyle factors are being discussed routinely between physicians and patients. The results from this MSD-sponsored survey were released today at the 48th Annual Meeting of the European Association for the Study of Diabetes (EASD). MSD is known as Merck in the U.S. and Canada.

Multiple professional groups, including the EASD and the American Diabetes Association (ADA)^2-5 recommend individualized treatment plans for effective management of type 2 diabetes. Guidelines also state that it is important to try to avoid low blood sugar and reduce the risk of serious complications such as heart disease and stroke. Of note, the survey uncovered several individual lifestyle considerations, including emotional well-being, occupation and working hours, and cultural influences, are not always addressed.

According to the Living Diabetes survey, conducted by research company Bryter:

• When thinking about the last time they experienced low blood sugar, 44% of patients stated they were working.¹ In addition, one-quarter (25%) of patients always/frequently or sometimes skipped meals as a result of their occupation and working hours¹
• 76% of patients did not recall discussing their occupation and working hours during routine check-ups¹
• Additionally, nearly two-thirds (64%) of patients did not recall discussing emotional health with their physician.¹

"Diabetes is a prevalent global public health issue, with about half of patients not achieving adequate blood sugar control," said Dr Wasim Hanif, Consultant Physician and Honorary Senior Lecturer in diabetes and endocrinology at University Hospital Birmingham, UK, and Chair of the Living Diabetes steering committee that oversaw the research. "To help address diabetes management, physicians and patients need to discuss factors that can impact blood sugar control. A patient with diabetes who works night shifts or fasts for religious reasons needs a different treatment plan than a patient who is retired or works days, for example."

The Importance of Recognizing Low Blood Sugar
Early and effective management of blood sugar is a critical component of a successful treatment plan. It is also important to try to avoid episodes of low blood sugar which sometimes can lead to fainting and in more severe cases loss of consciousness, convulsions or seizures that require immediate treatment.⁶

For people with type 2 diabetes, numerous lifestyle factors and certain diabetes medications are known risks for low blood sugar.⁷ However, nearly half (48%) of those surveyed stated that medication options were not discussed at routine check-ups with their physician.¹

Blood sugar management continues to challenge people with diabetes. According to the survey:

• 53% of patients reported having experienced symptoms of low blood sugar at least once¹ but only 37% stated they had discussed low blood sugar with their physician during routine check-ups¹
• 28% of patients reported their physician had never talked to them about the warning symptoms of low blood sugar¹
• Almost one-third (31%) said their physician had not ever talked to them about ways to reduce their risk of low blood sugar¹
• More than half (57%) of patients indicated that they would have liked additional information from their physician about the signs and symptoms of low blood sugar.¹

"Patients should discuss low blood sugar with their physicians, particularly those taking medicines known to increase the risk of low blood sugar," said Dr Hanif. "While it is encouraging that the survey showed diet and physical activity are being addressed, it is important to remember there are other lifestyle factors that can also impact blood sugar control," said Dr Hanif.

Heart Disease Focus Needed Too
People with type 2 diabetes have an increased risk of heart disease and stroke. Blood sugar (HbA1c), blood pressure and cholesterol levels⁸ should also be managed as part of a patient's diabetes treatment plan. Nearly half (45%) of patients reported they did not discuss cholesterol at routine check-ups¹ with their physician and 30% of patients had rarely or never discussed factors that increase the risk of heart disease.¹

"Managing diabetes and cardiovascular risk go hand in hand, since heart disease and stroke are leading complications of diabetes," adds Dr Hanif. "Patients should talk to their doctors about setting goals for their blood sugar, blood pressure, and cholesterol, as well as developing an individualized treatment plan that is right for them."

The "Big Picture" – A Growing Problem
Diabetes affects 366 million people globally, and 90 to 95 percent of diagnosed cases of diabetes are type 2 diabetes.^9,10 According to the International Diabetes Federation (IDF) the number of people living with diabetes is expected to rise to 552 million by 2030.⁹ According to National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2006, overall about half of people with diabetes achieve adequate blood sugar control (HbA1c < 7.0%), approximately 42% achieve target cholesterol levels (LDL cholesterol < 100mg/dL) and overall target blood pressure of <130/80mmHg, is achieved by approximately 43% of patients.¹¹

About the Living Diabetes Program
Living Diabetes: Journey for Control is part of MSD's educational program, supported by an expert steering committee, and aims to increase awareness of the significant need for individualized treatment of type 2 diabetes that will ultimately support improved blood sugar control and overall diabetes management.

The 2012 Living Diabetes survey was conducted online by Bryter on behalf of MSD between June 27 and August 10, 2012 in eight countries, including Australia, China, Germany, India, Mexico, Saudi Arabia, the United Arab Emirates and the United Kingdom. A total of 807 interviews were conducted among hospital-based physicians (diabetologists, diabetes specialists, endocrinologists), general practitioners (primary care physicians and family care physicians), and 899 adults diagnosed with type 2 diabetes. No estimates of theoretical sampling error can be calculated; a full methodology is available.

In follow up to the survey results, MSD has launched a lifestyle checklist for patients to use when visiting their doctor to remind them to discuss every relevant aspect of their life when attending a routine check-up. The checklist is now available on request from MSD.

The steering committee consisted of:

• Dr Wasim Hanif, Chair of the steering committee and Consultant Physician and Honorary Senior Lecturer, University Hospital Birmingham, UK
• Dr Khalid Al-Rubeaan, Director of the Diabetes Center at King Saud University, Saudi Arabia
• Dr Rosario Arechavaleta, Assistant Professor of Endocrinology at the Endocrine Service of Hospital Especialidades del Centro Medico de Occidente del Instituto Mexicano del Seguro Social in Guadalajara, Mexico
• Dr Jen Nash, Clinical Psychologist, UK
• Claudia Leippert, Diabetes Specialist Nurse and Vice President of the Nurses in Diabetes Association, Germany.

About Bryter
Bryter works for the world's top healthcare companies, together with world leading technology, telecommunications and manufacturing organizations. Bryter utilizes innovative qualitative and quantitative techniques, together with advanced analytics to deliver insights that enable its clients to navigate and understand the global landscape. Bryter services clients across five continents, delivering research studies that have covered over 50 countries. Bryter's work allows companies to make the most of growth opportunities, through research based insight and consultancy. For further information please visit www.bryter-research.co.uk.

About MSD
Today's MSD (known as Merck in the United States and Canada) is a global healthcare leader working to help the world be well. MSD is a trade name of Merck & Co., Inc. with headquarters in Whitehouse Station, N.J., U.S.A. Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to healthcare through far-reaching policies, programs and partnerships. For more information, visit www.msd.com.

References

1. MSD. Living Diabetes: Journey for Control Survey. 2012
2. International Diabetes Federation. Global guideline for Type 2 Diabetes. 2005
3. American Diabetes Association. Position Statement: Standards of Medical Care in Diabetes – 2012. Diabetes Care (35), Supplement 1, January 2012
4. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. Endocrine Practice Vol 17 (Suppl 2) March/April 2011
5. Position Statement of the ADA and EASD. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach. Diabetes Care, Vol 35, June 2012
6. Mayo Clinic. Diabetic Hypoglycemia. 2012. Found at: http://www.mayoclinic.com/health/diabetichypoglycemia/DS01166 Accessed on 1 September 2012
7. Bodmer et al. Metformin, Sulfonylureas, or OtherAntidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia. Diabetes Care: Vol 30 No.11, 2086-2091, 2008
8. IDF Factsheet: Diabetes and CVD 2012 Found at: http://www.idf.org/fact-sheets/diabetes-cvd Accessed 5 September 2012.
9. International Diabetes Federation. Diabetes Atlas, 2012. Found at: http://www.idf.org/diabetesatlas/5e/the-global-burden Accessed 5 September 2012.
10. International Diabetes Federation. Why Diabetes? 2012. Found at: http://www.idf.org/the-campaign/unite-for-diabetes/why-diabetes Accessed 5 September 2012.
11. Cheung et al. Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006. The American Journal of Medicine: Vol. 122, No 5. 443-453, May 2009

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SOURCE: MSD (known as Merck in the United States and Canada)

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