Diabetes Technologies: We Are All in This Together.

Abstract

The United States faces a shortage of both primary care physicians (PCPs) and endocrinologists—the two groups of clinicians who provide the majority of care to people with diabetes (1–3). Patients treated with intensive insulin therapy, including all of those with type 1 diabetes and many with type 2 diabetes, face numerous daily self-management decisions. These decisions include factoring insulin dosing, glucose management, diet, activity, and other behavioral factors into their decision-making. These patients stand to gain from using the treatment and monitoring technologies that are rapidly advancing and accumulating evidence in support of their benefits. Despite this situation, the actual use of such technologies, including continuous glucose monitoring (CGM) and closed-loop artificial pancreas systems, remains relatively low (4,5). One potential barrier to uptake of such advanced diabetes technologies is a hypothesized mismatch between geographical location of people with diabetes and available clinicians. Employing datasets from the U.S. Census Bureau (6) and the American Medical Association Health Workforce Mapper (7), as well as prevalence estimates from the American Diabetes Association and JDRF, we sought to compare the distribution of PCPs and endocrinologists across the United States to the distribution of people with diabetes. This endeavor was undertaken as a step toward understanding whether encouraging PCP …