Physician–patient communication at prescription of an additional oral drug for type 2 diabetes and its links to patient outcomes – New findings from the global IntroDia® study

Edelman, Steven V.; Belton, Anne; Down, Su; Alzaid, Aus; Capehorn, Matthew; Gamerman, Victoria; Nagel, Friederike; Lee, Sang Hoon; Emmerson, James; Polonsky, William H.

doi:10.1016/j.diabres.2019.01.020

Cited by 12 publications

(23 citation statements)

References 25 publications

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“…A Danish study showed that low frequency of self‐monitoring of blood glucose, perceived low treatment efficacy, low adherence, and low primary care utilization were associated with high levels of HbA 1c and LDL cholesterol . In the multinational IntroDia study approximately one in five people with type 2 diabetes negotiated with their physician to delay additional medication after initial monotherapy, two‐thirds successfully . A justifiable source of variation is individualized targets due to multimorbidity and short life expectancy, individual preferences and resources.…”

Section: Discussionmentioning

confidence: 99%

Variation in the achievement of HbA_1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

et al. 2019

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To identify population, general practitioner, and practice characteristics associated with the achievement of HbA 1c , blood pressure and LDL cholesterol targets, and to describe variation in the achievement of risk factor control. Methods We conducted a cross-sectional survey of 9342 people with type 2 diabetes, 281 general practitioners and 77 general practices in Norway. Missing values (7.4%) were imputed using multiple imputation by chained equations. We used three-level logistic regression with the achievement of HbA 1c , blood pressure and LDL cholesterol targets as dependent variables, and factors related to population, general practitioners, and practices as independent variables. Results Treatment targets were achieved for HbA 1c in 64%, blood pressure in 50%, and LDL cholesterol in 52% of people with type 2 diabetes, and 17% met all three targets. There was substantial heterogeneity in target achievement among general practitioners and among practices; the estimated proportion of a GPs diabetes population at target was 55-73% (10-90 percentiles) for HbA 1c , 36-63% for blood pressure, and 47-57% for LDL cholesterol targets. The models explained 11%, 5% and 14%, respectively, of the total variation in the achievement of HbA 1c , blood pressure and LDL cholesterol targets. Use among general practitioners of a structured diabetes form was associated with 23% higher odds of achieving the HbA 1c target (odds ratio 1.23, 95% confidence interval (CI) 1.02-1.47) and 17% higher odds of achieving the LDL cholesterol target (odds ratio 1.17, 95% CI 1.01-1.35). Conclusions Clinical diabetes management is difficult, and few people meet all three risk factor control targets. The proportion of people reaching target varied among general practitioners and practices. Several population, general practitioner and practice characteristics only explained a small part of the total variation. The use of a structured diabetes form is recommended.

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Section: Discussionmentioning

confidence: 99%

Variation in the achievement of HbA_1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

et al. 2019

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“…The first part of addressing diabetes distress occurs in the 1:1 interactions with a diabetes care provider. People's perceptions of good communication and positive relationships with providers are associated with reduced diabetes distress, improved outcomes, higher levels of self‐care and higher confidence in following recommendations . Global studies indicate that good communication is reflected in greater use of collaborative and encouraging conversation elements .…”

Section: Management Of Distress: Individual Interactionsmentioning

confidence: 99%

“…People's perceptions of good communication and positive relationships with providers are associated with reduced diabetes distress, improved outcomes, higher levels of self‐care and higher confidence in following recommendations . Global studies indicate that good communication is reflected in greater use of collaborative and encouraging conversation elements . Patients define collaborative care as listening and learning from each other, sharing ideas, agreeing on measurable goals and support with goal achievements .…”

Section: Management Of Distress: Individual Interactionsmentioning

confidence: 99%

Twenty‐five years of diabetes distress research

2019

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The term ‘diabetes distress’ first entered the psychosocial research vernacular in 1995, and refers to ‘the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes’. At first the proponents of the concept were hesitant in advocating that diabetes distress was a major barrier to individuals’ self‐care and management of diabetes. Since then, a burgeoning body of evidence, now including several systematic reviews of intervention studies, suggests that diabetes distress, in both type 1 and type 2 diabetes, across ages and in all countries and cultures where it has been studied, is common and can be a barrier to optimal emotional well‐being, self‐care and management of diabetes. As a consequence, monitoring diabetes distress as part of routine clinical care is part of many national guidelines. The present narrative review summarizes this research and related literature, to postulate the aetiology of diabetes distress, and thus how it may be prevented. The current evidence base for the management of diabetes distress is summarized, and the next steps in the prevention and management of diabetes distress identified.

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“…The results of a previous study suggested that patients' compliance after receiving education depends on the quality of the conversation between the medical team and patient at the time of diagnosis of type 2 diabetes mellitus (T2DM) [ 23 24 ]. A year-long study [ 25 ] in which diabetes education was conducted among T2DM patients in 10 countries showed a significant improvement in both blood glucose control and weight loss.…”

Section: Discussionmentioning

confidence: 99%

Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

Kim

Yang

et al. 2017

Diabetes Metab J

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BackgroundWhen patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels.MethodsThe study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.ResultsPatients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024).ConclusionFor patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

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Physician–patient communication at prescription of an additional oral drug for type 2 diabetes and its links to patient outcomes – New findings from the global IntroDia® study

Cited by 12 publications

References 25 publications

Variation in the achievement of HbA_1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

Variation in the achievement of HbA_1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

Twenty‐five years of diabetes distress research

Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

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Physician–patient communication at prescription of an additional oral drug for type 2 diabetes and its links to patient outcomes – New findings from the global IntroDia® study

Cited by 12 publications

References 25 publications

Variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

Variation in the achievement of HbA1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

Twenty‐five years of diabetes distress research

Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

Contact Info

Product

Resources

About

Variation in the achievement of HbA_1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control

Variation in the achievement of HbA_1c, blood pressure and LDL cholesterol targets in type 2 diabetes in general practice and characteristics associated with risk factor control