Lansang EZ, Tang V, Ranade S, Caveney E, Ng N, Saldanha LM, Lee KJ and Wai K
Introduction: A patient care pathway is the referral pathway from a patient’s first consult with a healthcare provider to the time they receive the most appropriate treatment for their condition. With the increase in diabetes prevalence, clinical trial growth in Asia, and lack of published literature in this area, it is critical to understand the patient care pathway of Type 2 Diabetes Mellitus in the region.
Method: Between March and August 2013, a survey investigating the diagnosis and treatment patterns of diabetes and diabetes-related complications was sent to healthcare offices in 11 Asian countries. Survey responses received were analyzed.
Results: Eighty-seven healthcare offices were contacted, out of which, 49, returned the surveys. Fifty-seven percent of physicians who responded were endocrinologists, 24% were self- reported diabetologists, and 14% were general practitioners. Internists/general practitioners diagnose majority of type 2 diabetics, and they manage majority of diabetes patients treated only with lifestyle therapy. Internists and endocrinologists manage most patients on oral anti-hyperglycemic agents. Endocrinologists/diabetologists treat a majority of patients on insulin and GLP-1 agonists. Specialists such as cardiologists and nephrologists manage those with more severe complications.
Discussion: The diabetes patient care pathway has several suggestions on the target physician group for clinical trials, namely (1) Internal medicine doctors and primary healthcare physicians may be potential investigators or referral sites for clinical trials requiring treatment naïve diabetic patients; (2) diabetologists/endocrinologists should be considered for clinical trials needing patients on pharmacologic treatment, whether oral or insulin; (3) internists may play a role in trials that involve patients on oral anti-hyperglycemic agents and on insulin; (4) the severity of diabetic complications impacts the medical specialty of the physician treating patients; and (5) cardiologists and nephrologists are important considerations for studies with cardiovascular or nephrology related outcomes.
