Diabetes Fellowship in Primary Care: A Survey of Graduates.

CONTEXT: The diabetes pandemic has outpaced the US supply of diabetes specialists and has overwhelmed primary care providers (physicians, physician assistants, and nurse practitioners). Primary care diabetes fellowships can be used to address this workforce shortage. OBJECTIVES: To determine the skills obtained during 2 diabetes fellowship programs, the barriers encountered in practice, the impact of the programs on career paths, and perceived acceptance by patients and colleagues. METHODS: A Qualtrics link to a 26-item survey was sent via email to all graduates of the Ohio University Heritage College of Osteopathic Medicine and East Carolina University Brody School of Medicine diabetes fellowship programs. Items included demographic information, comfort level with different clinical diabetes skills, and current system barriers encountered in their practices. RESULTS: Of 39 graduates, 36 completed the survey. The most beneficial skills acquired during the fellowship were insulin pump management (13 [36%]), insulin management (10 [29%]), and diabetes pharmacology (6 [17%]). The most common barrier was the lack of board certification as a diabetologist, which affected time with patients and insurance reimbursement. The perceived acceptance by patients was high (25 [69%]), and the perceived receptiveness by colleagues was mostly neutral (7 [19%]) or positive (10 [29%]). The most common postfellowship career path was primary care medicine (15) followed by hospitalist (7) and diabetologist (5). CONCLUSION: Physicians who completed the diabetes fellowship training reported high comfort levels with treating patients with diabetes, but they also reported the barriers faced in an unrecognized specialty.

Can lifestyle interventions do more than reduce diabetes risk? Treating depression in adults with type 2 diabetes with exercise and cognitive behavioral therapy.

The epidemic of metabolic syndrome, prediabetes, and type 2 diabetes is global in scope and comprehensive in its impact on individuals, health care systems, and societies. One in four patients with diabetes will experience depression in their lifetime. Comorbid depression is associated with poorer outcomes, greater functional disability, and early mortality. Prior studies have demonstrated beneficial effects of exercise as an efficacious form of treatment for depression in the general population. Few studies have evaluated this strategy in patients with prediabetes or type 2 diabetes. Program ACTIVE (Appalachians Coming Together to Increase Vital Exercise) was designed to treat depression among adults with type 2 diabetes by pairing aerobic activity with individual cognitive behavioral therapy. This combination treatment approach has been shown to be feasible to implement in a rural environment and promising in terms of depression, diabetes, and cardiovascular outcomes. Data from this study suggest that exercise can be used to achieve multiple benefits for adults with type 2 diabetes. Future work to compare this approach to singular treatment strategies for adults at risk for type 2 diabetes is needed.

High self-reported prevalence of diabetes mellitus, heart disease, and stroke in 11 counties of rural Appalachian Ohio.

UNLABELLED: CONTEXT/PURPOSE: There is an epidemic of obesity and diabetes in the United States, especially in economically at-risk populations such as rural Appalachia. This survey determined the self-reported prevalence of obesity, diabetes mellitus, and associated macrovascular complications in 11 rural counties of Appalachian Ohio. The impacts of lifestyle, cardiovascular risk factors, income, and access to medical care were also determined. METHODS: A telephone survey identical to the 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was conducted. Surveys were collected from 3,927 randomly selected residents 18 years of age and older in 11 counties of Appalachian Ohio and compared to published aggregate Ohio and national 2004 BRFSS data. FINDINGS: The self-reported prevalence of diabetes (11.3%) was markedly higher in Appalachian Ohio counties surveyed compared to aggregate Ohio (7.8%) or national (7.2%) 2004 BRFSS data (P < .044). The prevalence of heart disease (7.6%) and stroke (4.1%) in these counties was slightly higher than aggregate Ohio or national 2004 BRFSS data. In persons with diabetes, the prevalence of heart disease was 2-fold higher (20.0%) and stroke 3-fold higher (11.4%) than among nondiabetics (P < .042) in the region and higher than aggregate Ohio and National 2004 BRFSS data. Lower-income levels and decreased access to medications and glucose monitoring supplies correlated with the increased risk for cardiovascular complications in this rural population (P < .042). CONCLUSION: The self-reported prevalence of diabetes mellitus and its associated macrovascular complications are much higher in rural Appalachian Ohio compared to aggregate Ohio and National 2004 BRFSS data.