Physicians are less likely to provide preventive care such as conception counseling and some cancer screenings to women with diabetes than they do for women without the disease, a UCLA-led study suggests.
The findings, to be published April 3 in the peer-reviewed Journal of General Internal Medicine, are based on a detailed analysis of more than 40 studies from several countries. They spotlight how physicians largely overlook the importance of these routine services to women who have Diabetes Mellitus (DM), putting them at risk for preventable medical conditions such as pregnancy complications.
"These findings are important because they identify that women with diabetes are not receiving recommended well-woman care, which is essential to support both managing their diabetes and their overall health,” said senior author Lauren Wisk, an associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “Providers need to be aware that they should not forget to provide these essential services for women with diabetes.”
The researchers sifted through thousands of studies, focusing on concepts of “women,” “diabetes,” and “Women’s health services” and settled on 44 that addressed treatment services for women ages 15 to 49 years with type 1 or type 2 diabetes, exclusive of those with diabetes insipidus or gestational diabetes. They specifically looked at four preventive health service categories: contraceptive counseling and use, breast/cervical cancer screening, pre-conception counseling, and screening for sexually transmitted infections.
Here are key findings from the studies the researchers reviewed:
- One study found that 48% of women with diabetes received contraceptive services vs. 62% of women without the disease
- Nine papers showed cervical cancer screening rates ranging from 38% to 79% for women with diabetes compared with a 46% to 86% rate for those without diabetes.
- Four studies concluded that breast cancer screenings rates for women with diabetes ranged between 38% and 69% compared with 54% and 82% for those without diabetes
- Fourteen studies found pre-conception counseling rates of just over 1% compared to 46% for women with diabetes who are planning to get pregnant.
The researchers did not identify any studies on screenings for sexually transmitted infections, which they said represents “a substantial gap in the literature.”
“One of the more striking findings of this review is the importance of robust coordinated care teams in ensuring access to appropriate services for women with DM,” the researchers write. “Several of the identified studies provide support that a co-management model, or the concept of involving endocrinology, primary care, and other specialty care providers in the care of individuals with DM (as recommended by the American Diabetes Association), is associated with greater receipt of services.”
Within the time constraints of an office visit, primary care physicians are expected to address preventative health needs as well as chronic disease management, said Dr. Lisa Kransdorf, an associate clinical professor of medicine at the Geffen School and a study co-author. Frequently the chronic disease management will take priority.
“In cases where the patient has other providers such as specialists and clinical pharmacists actively involved in their chronic disease management, there is opportunity for primary care physicians to attend to preventative care gaps,” she said.
There are some limitations to the findings. The search yielded only 44 studies, many of which relied on patient recall, which can be unreliable, and highlighting the need for further research. In addition, most of the studies analyzed had small sample sizes or were conducted at a single site, limiting how applicable the findings might be in other settings.
“Future research should look into how health systems should use electronic health records to increase preventive health services among women with diabetes, improve care-coordination and communication between healthcare providers, and evaluate co-management models' quality of care,” Wisk said.
A UCLA Faculty Career Development Award funded this study.
Study co-authors are Dr. Madeline Treasure, Dr. Pourandokht Nourbakhsh. Kate Diaz Roldan, Antonia Osuna-Garcia and Dr. Lisa Kransdorf of UCLA, and Sara Esteves of Creighton University.
