Diabetes Care

Implications of Specialist Density for Diabetes Care in the United States

Ravi B. Patel, MD¹; Mahmoud Al Rifai, MD, MPH²; John W. McEvoy, MB, BCh, MHS^3,4,5; et alMuthiah Vaduganathan, MD, MPH⁶

Author Affiliations Article Information

JAMA Cardiol. Published online October 23, 2019. doi:10.1001/jamacardio.2019.3796

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Editorial

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For the first time, antihyperglycemic therapies are available to modify cardiovascular disease courses in type 2 diabetes . Two therapeutic classes (sodium-glucose cotransporter inhibitors and glucagon-like peptide-1 receptor agonists) are now recognized to be associated with multisystem health and reductions in cardiovascular and kidney outcomes. Despite the ongoing expansion of the evidentiary base supporting their use and the broadening of regulatory labels of select sodium-glucose cotransporter inhibitors and glucagon-like peptide-1 receptor agonists, their prescription has been largely restricted to primary care physicians and endocrinologists.^1,2 Primary care physicians treat approximately 90% of individuals with type 2 diabetes nationally.³ However, high-risk patients with type 2 diabetes commonly encounter various internal medicine specialists because of high rates of comorbidities and clinical events.⁴ We therefore characterized the distribution of internal medicine specialists in the United States who may be able to provide care for the growing population with diabetes.