Diabetics Not Getting Adequate Treatment, Specialists Contend

Physicians still in training were 25 percent more likely to "intensify" treatment than those out in practice, the researchers found. Comparing physicians who were 10 years apart in age, they also found that the older ones were 14 percent less likely to step up treatment.

"While the physicians do react to increased risk, they clearly are not reacting enough," Turchin said.

In another study, Shari Bolen of Johns Hopkins University School of Medicine examined the records of 254 people with diabetes and hypertension in a managed-care plan for government employees.

From 1999 through 2001, there were about 1,400 visits to primary-care physicians in which the patient had blood pressure that was too high. In only 12 percent of visits, however, did the doctor intensify treatment. The physician was twice as likely to act if the patient came in for a routine visit rather than for an immediate problem.

Ironically, patients who were also seeing a heart specialist were less likely to have their dosages increased than if they were under the care of a primary-care doctor only.

"Each may think the other is taking care of the hypertension," Bolen said.

A third study looked at what happened to about 9,500 people after they were first prescribed a diabetes drug. All were treated in a national managed-care plan.

The researchers looked at how doctors reacted to readings on a test called "hemoglobin A1C," which physicians use to judge a patient's blood-sugar levels over a prolonged period -- two or three months. The results are expressed as a percentage -- the higher the average blood sugar, the higher the percentage. The target should be no more than 7 percent, according to the Diabetes Association.

At the start of treatment, the average for patients in the study was 8.4 percent -- no surprise. However, it took an average of 240 days before their doctors intensified treatment, and by then the average reading was higher than at the outset. More than 60 percent of the patients were approaching 10 percent, a markedly high reading. The study was conducted by Craig A. Plauschinat, a pharmacist with Novartis Pharmaceuticals Corp.

In the fourth study, Steve Gough, a diabetologist at Britain's University of Birmingham, looked at the most recent hemoglobin A1C levels of about 3,700 diabetic patients in Germany and England who were taking insulin. The average was 8.4 percent for the Germans and 8.1 percent for the Britons -- both abnormal. Nearly one in five had levels above 10 percent.

About half of patients with Type 2 diabetes will ultimately need to switch from pills to insulin injections, a big step. This study suggested that once it is made, physicians let up.

"Patients and doctors seem to get stuck at one injection a day," Gough said. "They seem not to be able to progress" to more intensive treatment.

In Britain's national health system, Gough said, physicians are starting to receive points for following specified guidelines, such as routinely prescribing cholesterol-lowering drugs to diabetics, advising them to take a daily aspirin or reaching blood-pressure goals.

A practitioner who accumulates enough points gets a cash bonus. The program has increased the percentage of patients hitting the recommended targets, Gough said, adding:

"They are doing what they are paid for, but it's extra money, and that's the reality of it."