Awareness of pathophysiological concepts of type 2 diabetes: a survey in 847 physicians

The aim of the study was to determine physicians' knowledge of specific concepts generally implicated in the pathophysiology of type 2 diabetes (T2D).

A multiple choice online survey was completed by 847 physicians, of which 516 were engaged in primary care (PCP) and 331 in specialized care (SCP) in the US, the UK, Germany and France (3-30 years in practice, at least 40 patients with T2D). A continuous rating system was used to measure familiarity ("totally familiar" to "never heard of") or agreement with a statement (from "totally agree" to "totally disagree").

The term "insulin resistance" was recognized by 74% of PCPs and 90% of SCPs (p<0.05) and 76% felt that it was "a key but not the sole determinant of T2D". Only 47% agreed that "beta cell dysfunction is a key determinant of T2D onset" and 57% agreed with "beta cell dysfunction being a key determinant of T2D progression". Even among SCPs, 6% were not familiar with the term "beta cell dysfunction" (16% among PCPs, p<0.05). The overall familiarity with the following terms was: 55% with "beta cell dysfunction", 56% with "beta cells", 38% with "glucagon", 32% with "alpha cells", 55% with "hepatic glucose output", 15% with "incretins" and 18% with "GLP-1". SCPs were significantly more familiar with all terms than PCPs (all p-values <0.05).

The pathogenetic role of beta cell dysfunction in the onset and progression of T2D did not seem to be well established. "Insulin resistance" was a well known concept even among PCPs, while "hepatic glucose output", "pancreatic alpha cells" and "glucagon" were not. Incretin hormones and GLP-1 were widely unknown. This may effect prescribing behaviour and how well an individual's therapy is based on pathophysiology.