Approaching the manpower issue from another angle, Dr. Hirsch said his recent informal, nonscientific survey of adult endocrinologists in St. Louis, Seattle, Los Angeles, and Chicago suggests type 1 diabetes typically accounted for 20% of their patient load. Again, that doesn't come close to meeting demand.
"No matter how one does the math, type 1 diabetes in adults will by necessity be cared for by the primary care physicians," he said.
But that's not realistic, either, the way primary care medicine is practiced at present, he quickly added. "In current internal medicine residency training, we put little or no emphasis on insulin therapy in general, let alone type 1 diabetes. And current primary care systems lack an infrastructure for insulin therapy, let alone pumps, sensors, and the like," according to Dr. Hirsch.
And then there are the brutal time constraints imposed on primary care practice, he continued, citing a recent survey of 2,500 family physicians which showed that patients with well-controlled diabetes were on average allocated just two 10-minute office visits per year for their chronic disease.
Through the Helmsley Trust project, diabetes researchers expect to generate much more specific figures as to the actual time primary care physicians spend in managing type 1 diabetes in adults, he added.
Dr. Hirsch declared having no financial conflicts regarding his presentation.