Doctor patient disconnect could have serious implications for diabetics

Doctors and patients with diabetes are not communicating as well as they should, according to a national survey from McMaster University in Hamilton, Ontario, and that could have serious health implications for patients.

A survey of 760 diabetic patients and 301 physicians from across Canada found that doctors and patients differed on what they thought were the most important complications of diabetes.

Doctors listed heart disease, declining kidney function and stroke as the leading complications of the condition, while patients were worried about blindness, amputation and heart disease.

Dr. Richard Tytus, a family physician and associate clinical professor at McMaster University and a contributor to the survey, says doctors should be worried because patients are not paying attention to what is really important.

“Patients are underestimating the life-threatening impact of heart or kidney complications and focusing more on less fatal complications. The reality is that you won’t need to worry about being blind if your heart stops beating or your kidneys shut down. It all starts in your kidneys. If you can prevent it from progressing, you won’t have the complications of going blind or amputations.”

The survey revealed that only 44 per cent of patients were worried about declining kidney function and 47 per cent did not even realize they were at high risk of developing kidney disease because they were diabetic.

Dr. Tytus says these statistics are alarming given that chronic kidney disease associated with diabetes is the leading cause of kidney failure in Canada.

“High blood glucose causes damage to the delicate blood vessels in the filters of the kidneys, and as the diabetes progresses, these filters can become so damaged that the kidneys fail,” he explained.

According to the Kidney Foundation of Canada, “kidney disease usually progresses silently, often destroying most of the kidney function before causing any symptoms. “

“By the time you are having problems, it is too late. The horse has left the barn. So be aware now. Be pro-active and ask the doctor to help me, help myself,” said Dr. Tytus.

The kidneys are important in regulating water removal and retention and in removing toxic waste products from bodily fluids. When the kidneys fail, wastes and fluids accumulate in the body and patients will need dialysis treatments or a kidney transplant or face the possibility of death.

Terry Young, president of the Ontario Branch of the Kidney Foundation knows that all too well. He endured kidney dialysis for two years and had a kidney transplant at the age of 17. It involved going to the hospital two to three times a week and being hooked up to a machine for several hours. His brother is diabetic and is now suffering kidney failure and will eventually need dialysis.

Young says you can’t under estimate the importance of knowing how diabetes affects your kidneys.

“What is not right in front of you but down the road is increased risk for kidney failure,” said Young. “That will have a significant impact on your life. What this study shows is that we need to draw awareness to diabetes patients of the risks.”

There are currently 10, 000 patients on dialysis in Ontario and 1, 000 of them are waiting for a kidney transplant.

Dr. Tytus of McMaster University says 50 per cent of patients with diabetes will develop kidney disease and “if you have diabetes and declining kidney function, your chance of a heart attack or stroke doubles. “

The survey also reveals that almost eighty per cent of the doctors said they told their patients about the impact of diabetes on kidney function, while only a little over 50 per cent of patients recalled having that same conversation. Almost 60 per cent of patients said they were never told about the risks of diabetes on their kidney health at all.

Facts on Diabetes from the Canadian Diabetes Association

•An estimated 285 million people worldwide are affected by diabetes.

•7 million people develop diabetes each year. This number is expected to be 438 million by 2030.

•Diabetes is a contributing factor in the deaths of approximately 41,500 Canadians each year.

•More than 20 people are diagnosed with the disease every hour of every day.

•9 million Canadians (1 in 4) live with diabetes or pre-diabetes.

•2.7 million have been diagnosed with diabetes.

•1 million are living with diabetes but have not yet been diagnosed.

•Of the 2.7 diagnosed and 1 million undiagnosed – 90 per cent are type 2, 10 per cent are type 1

•5.4 million living with pre-diabetes

•80% of Canadians with diabetes die from a heart attack or a stroke.

•42% of new kidney dialysis patients in 2004 had diabetes.

•Diabetes is the single leading cause of blindness in Canada.

•7 of 10 non-traumatic limb amputations are the result of diabetes complications.

•The life expectancy for people with type 1 diabetes may be shortened by as much as 15 years.

•The life expectancy for people with type 2 diabetes may be shortened by 5 to 10 years.

The national survey on doctor-patient communication with regard to complications was conducted by Vision Critical in partnership with The Kidney Foundation of Canada, Boehringer Ingelheim (Canada) Ltd. and Eli Lilly Canada.