The goals of Type 2 diabetes (T2DM) management include achievement of glycemic, blood pressure (BP), and lipid control. All three variables must be addressed adequately in order to prevent diabetic complications. Aim: Using a proprietary smartphone-based application (APP) developed by Edocate Ltd, that simulates virtual visits, we assessed how well healthcare providers (HCPs) manage T2DM. Materials & Methods: A total of 461 HCPs (247 MD, MD/PhD, or DO and 214 NPs) downloaded and used the APP to treat their virtual patients over multiple visits. All patients presented with poorly controlled T2DM, hypertension (HTN) and hyperlipidemia. HCPs chose the first, second and third lines of medications, made diagnostic adjustments, initiated appropriate referrals to specialists, and ordered laboratory tests of their choice. Based on their selections, the APP simulated the course of diabetes and its complications, requiring diverse management decisions on the subsequent virtual visits. Results: In the Edocate virtual clinic, only 53% of HCPs achieved good glycemic control (A1c < 7%), 41% achieved BP control (<130/80 mmHg), and 66% prescribed high-intensity statins. NPs performed slightly but not significantly better than the physician cohort. Only 48% of HCPs checked microalbuminuria, 54% ordered creatinine and 55% ordered LDL. Interestingly, 79% of HCPs either kept or started Metformin as the first line medication. The most commonly ordered second line of medications for glycemic control was either GLP-1 receptor agonists (39%) or SGLT2 inhibitors (36%), while 23% of HCPs kept their patients on or added sulfonylurea or basal insulin (11%). Conclusions: Despite a worldwide effort in diabetes education, the knowledge of T2DM management remains suboptimal (as assessed by the simulation APP) and underscores the need for better professional education. Innovative patient simulation-based learning applications can dramatically improve the level of competency in HCPs. Disclosure B. Draznin: None. I. Iancu: None.
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