Diabetes mellitus currently affects 17 million people in the United States, with the vast majority, 8% of the adult population, having Type 2 Diabetes Mellitus (T2DM). It has become epidemic in the past several decades due to the advancing age of the population, increased prevalence of obesity and decreased physical activity. Diabetes causes considerable morbidity and mortality. The major complications are related to the micro- and macrovascular complications of the disease. The major macrovascular complication is atherosclerosis with an increased risk of a cerebrovascular accident and/or a myocardial infarction. The major microvascular complications are retinopathy, nephropathy, and neuropathy. Type 2 diabetes contributes to more cases of adult onset loss of vision, renal failure and amputation than any other disease. Patients with Type 2 diabetes have two to four times the risk of cardiovascular disease and 70% die of cardiovascular disease.1
The scientific literature was examined and key points abstracted as scientific drivers for learning and enhanced patient care. With a national advisory board and unrestricted grant support, five T2DM scientific drivers were stated. A scientific driver is a brief statement based on the most current medical literature, medical faculty review, clinicians’ approval, and consensus statement of U.S. medical specialties. Scientific drivers usually focus on therapeutic areas. The drivers for T2DM were defined as:
– Driver One – Reducing blood glucose levels and HbA1c levels reduces the risk of diabetic complications. Intensive therapy has been shown to be superior to conventional therapy in terms of reducing glycemia and diabetic complications.
– Driver Two – When monotherapy with an oral agent is no longer adequate, combination therapy with 2 or more oral agents has been shown to significantly improve glycemic control.
– Driver Three – When oral monotherapy or combination oral therapy is no longer adequate, insulin can be added to the regimen to significantly improve glycemic control.
– Driver Four – Benefits of insulin therapy, such as improved outcomes and glycemic control, outweigh risks such as the potential for inducing hypoglycemia.
– Driver Five – Type 2 Diabetes Mellitus is a disease consisting of two components, insulin resistance and insulin deficiency.
A case-based learning module was written as part of the project. Priority groups are basic science faculty and students, clinical faculty, clinical students, and clinicians. U.S. medical schools were surveyed to determine the extent to which the five drivers were taught in Years 1, 2, 3, or 4. The five drivers seem to integrate the learning across the curriculum.2 The clinical faculty each teach the treatment of T2DM, the oral hypogenic agents, and the side effects of these drugs instead of insulin.
According to the Association of American Medical Colleges’ (AAMC’s) CurrMIT 3 database, 58 medical schools report the teaching of diabetes at some point during the basic sciences or clinical years. Although some have integrated basic sciences and clinical materials, there remains a deficiency on how schools view scientific evidence based medicine content for T2DM. Examples of doing so may be found in the CurrMIT database. U.S. medical schools have an assigned password from the Association of American Medical Colleges to access this data.
In interviews with faculty, it was suggested that T2DM could be better taught in a coordinated and integrated manner that spans the four years of medical school. At this time, however, it appears that in most cases they are only being taught in single courses. It does not appear that they are being taught across all four years of medical school. Faculty may select the order of the drivers and perhaps begin with driver 5, learning about pathology conditions first. Biochemical parameters (driver 2) and pharmacological treatments (driver 2, 3, and 4) could follow. The intent of this curriculum should provide the students an appropriate knowledge base to adequately treat patients.4
A poster presentation was provided attendees at the July 2003 International Association of Medical Science Educators annual meeting held at Georgetown. Several schools had extensive diabetes curriculum and formally commented about the intrinsic value of the five drivers. A summary of the schools that are successfully teaching the five drivers is listed in Table 1, “Schools Teaching T2DM Scientific Drivers.” A summary table of the schools’ representatives attending the July 2003 International Association of Medical Science Educators was developed from interviews and written surveys of the attendees. The attendees participated voluntarily. The results of these 18 representatives is summarized in Table 1, “Schools Teaching T2DM Scientific Drivers.” Based on interviews, the drivers are not taught in most of health sciences institutions internationally. There were 18 institutions where most of the drivers are taught. The best examples for the health sciences are listed in the table. These institutions serve as role models.
Summary of Table 1
Driver 1 18 out of 18
Driver 2 18 out of 18
Driver 3 17 out of 18
Driver 4 13 out of 18
Driver 5 16 out of 18
The T2DM health crisis can be improved by these learning activities. The five drivers are based on scientific evidence based medicine and can facilitate curriculum planning, integration, deployment, and evaluation. However, it is suggested basic science and clinical faculty learning teams be assembled to address chronic and end stage disease states. For each of these conditions, scientific drivers can be identified to guide integrated learning, curriculum and assessment across therapeutic areas.
- Winer, N. Sowers, Jr. Epidemiology of Diabetes. Journal of Clinical Pharmacology. 2004; 44: 397-345.
- Norris, T., Cullison, J.W., and Fihn, J.D. Teaching Procedural Skills. Journal of General Internal Medicine. 1997; 12 (suppl2) S64-S70.
- Association of American Medical Colleges CurrMit Database. Washington, D.C. 2003.
- Gunzburger, L. Integrating Basic and Clinical Sciences via Type 2 Diabetes Mellitus. 7th Annual Meeting of the International Association of Medical Science Educators. July 19-22, 2003. Washington, D.C. U.S.A.
NOTE: Please refer to the original PDF file for Table 1.