Mayer B Davidson
Professor, Charles R Drew University, USA
Title: Comparison of insulin dose adjustments by primary care physicians and endocrinologists
Biography
Biography: Mayer B Davidson
Abstract
Primary care physicians (PCPs) are reluctant to start/intensify insulin. Two possible reasons are lack of time or (perceived)
and lack of ability. To test the latter, we developed 20 simulated cases based on patients’ meter downloads and assigned the
following insulin regimens: 3 basal insulin alone, 4 basal-bolus, 6 self-mixed-split, 5 premixed, 1 with U-500 regular insulin
and 1 with delayed responses to NPH insulin. The insulin dose adjustments of 9 PCPs and 9 endocrinologists were compared
to a Gold Standard (GS). The senior author has taught house staff, nurses, physician assistants and clinical pharmacists how to
adjust insulin doses for 50 years. A registered nurse (not an NP) taught these principles and supervised by PCPs who referred
patients to her lowered HbA1c levels of 111 taking insulin at referral from 11.0% to 7.3%. These computerized principles
served as the GS against which the PCPs and endocrinologists were compared. In 162 instances where the GS did not make
dose changes, the PCPs and endocrinologists also did not, 53% and 49% of the time, respectively. In 396 instances where the
GS did make dose changes, both groups did 67% of the time. The mean unit difference from the GS was significantly (P<0.01)
less with PCPs (-1.2) than with endocrinologists (-5.1). In conclusion, the abilities of PCPs to adjust insulin doses are like
endocrinologists suggesting that time constraints are a major barrier. Utilizing reports generated by these computerized insulin
dose adjustment algorithms after meters are downloaded in the office or remotely will save PCPs time and face-to-face visits if
done remotely. The latter telemedicine approach is economically feasible because of a CMS monthly fee of $42.