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Cardiovascular risk problematic for diabetics

Both the health care system and individual patient circumstances are cited with impeding efforts to prevent cardiovascular disease among patients with diabetes, a new study found. But doctors can help prevent heart disease -- the leading cause of diabetes-related death -- by working with patients to change behavior, says the study in the March-April Journal of the American Board of Family Medicine. Lead study author Jesse Crosson, PhD, recommends that physicians work with patients to develop a care plan and set achievable health goals. Physicians' efforts are most effective when the patient feels like the choices being made are part of a collaborative process, said Crosson, assistant professor of family medicine and director of the New Jersey Primary Care Research Network at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. Researchers interviewed 34 primary care physicians in California, Indiana, Michigan and New Jersey from April 2006 to February 2007. The study indicated that most of the physicians were unable to control their diabetic patients' heart disease risk factors because the patient- and health system-related barriers seemed insurmountable (www.jabfm.org/cgi/content/abstract/23/2/171/). Among the obstacles reported were some patients' inability to afford diabetes medications and inadequate technology that impeded physicians' access to previous medical records. Many physicians also reported frustration at being unable to improve patients' adherence to diabetic treatment recommendations. Crosson suggested that physicians create a registry of patients with diabetes to monitor how well each patient is controlling cardiovascular disease risk factors. He also recommended that practicing physicians and medical students learn motivational interviewing, a technique that helps patients attain the desire and confidence to make necessary behavioral changes. Peter Sheehan, MD, chair of the American Diabetes Assn.'s Cardiometabolic Risk Initiative, said physicians should look to staff to implement some of the strategies detailed in the study. The ADA's risk initiative aims to raise awareness of the impact of diabetes on heart disease and stroke. "We put too much responsibility on the doctors, when we can delegate a lot of these tasks to nonphysician personnel," Dr. Sheehan said. The full and original article can be found here: http://www.ama-assn.org/amednews/2010/03/22/prsd0323.htm
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