Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes

OBJECTIVES Studies were conducted to: 1) assess physicians' attitudes and practices in managing cardiovascular disease (CND) risks in diabetes; and 2) determine the awareness of CVD risks among diabetic patients. BACKGROUND Cardiovascular disease is the leading cause of premature death among diabetic patients. As diabetes is often seen as a "glucose-centric" disease, it is unclear whether diabetic patients are talking with their doctors about CVD and other key clinical parameters of diabetes care such as blood pressure and cholesterol. METHODS An online survey, was completed by a nationally representative sample of 900 physicians. The 95% confidence interval is approximately +/-2.5%. Before this study, a telephone survey of 2,008 people with diabetes was conducted using random, direct-dial screenings of U.S. households. RESULTS Ninety-one percent of physicians believe that their patients with diabetes are "very" or "extremely" likely to have a cardiovascular event. Although physicians report discussing CVD risk factors with 88% of their diabetic patients, they perceive their diabetic patients as being only moderately knowledgeable about their increased CVD risks. Sixty-eight percent of the people with diabetes do not consider CVD to be a serious complication of diabetes; they are more likely to be aware of complications such as blindness (65%) or amputation (36%) rather than heart disease (17%), heart attack (14%), or stroke (5%). Physicians perceive "poor compliance" with behavioral modifications and medication regimens as the greatest barriers to the management of CVD risks in diabetic patients. CONCLUSIONS Materials should be made available to help facilitate communication about CVD risks, and strategies for improving compliance with life-style modifications and multiple drug therapies should be explored. Efforts should continue to promote a comprehensive approach to the management of diabetes to include aggressive control of blood glucose and other CVD risk factors. (C) 2002 by the American College of Cardiology Foundation.