Impact of Physician Training on Diagnosis and Counseling of Overweight and Obese Asian Patients.

BACKGROUND AND OBJECTIVES: Obesity is widely underdiagnosed among Asians, due in part to a lack of physician awareness of the modified diagnostic criteria for Asians. This study investigated the effect of a physician training on accurately diagnosing obesity among and providing weight counseling to overweight and obese Asian patients. METHODS: Physicians (N = 16) from five primary care practices received 1 h of face-to-face training and other reminder resources (e.g., wallet card) describing the guidelines for the diagnosis of overweight/obesity among Asians, as well as weight counseling instruction. Chart reviews of overweight/obese Asian patients were conducted for the 12 months before the training (n = 198) and 3 months following the training (n = 163). Physician race (Asian/non-Asian) and clinic setting (private/academic) were included as outcome moderators. RESULTS: Patients were predominantly male (63.1 %), with a mean age of 46.0 years (SD = 14.9) and an average BMI of 28.2 (SD = 3.8). Across all physicians, 26.8 and 45.1 % of patients were accurately diagnosed as overweight or obese before and after the training, respectively (p < 0.05). The odds of a physician correctly diagnosing Asian patients as overweight or obese were 102 % higher at post-training after accounting for nesting of patients within physicians. Similarly, weight counseling was higher (65.0 %) following training compared to pre-training levels (43.9 %) but failed to reach significance (p = 0.06). CONCLUSIONS: Accurate identification and counseling of overweight/obese Asian patients can be improved by education and training. Universal adoption of race-specific guidelines will ensure more successful weight management and reduced morbidity in a rapidly growing Asian population.

Type 2 diabetes mellitus: managing hemoglobin A(1c) and beyond.

Comprehensive glycemic control, as demonstrated by desirable glycated hemoglobin A1c (HbA1c), postprandial glucose (PPG), and fasting plasma glucose (FPG) levels, is imperative for managing patients with type 2 diabetes mellitus (T2DM). It is important to minimize fluctuations in blood glucose levels, as they are thought to contribute to both the microvascular and macrovascular complications. The HbA1c measurement itself is not always indicative of the magnitude or frequency of glucose fluctuations during the course of a day. Therefore, treatment should be aimed at reducing not only HbA1c, but also PPG and FPG in order to achieve glycemic control. At the same time, patient safety should be a priority. Glycemic control also means minimizing hypoglycemic episodes, which elevate the risk for additional complications. In addition to being life-threatening, hypoglycemia may cause hypoglycemia unawareness and compromised counterregulatory mechanisms. It may also lead to serious short- and long-term effects, including cognitive impairment and dementia. As most patients are unable to maintain glycemic control on monotherapy, fortunately, effective combination regimens are available with agents having complementary mechanisms that act upon HbA1c, PPG, and FPG with minimal risk of hypoglycemia or weight gain.