Patient-centered diabetes care varies in intensity by both disease- and patient-related factors

Patient-centered diabetes care varies not only by disease-related factors but also by patient-related factors, such as educational level and diabetes distress, a recent study found.

Researchers in the Netherlands performed an observational study at 47 general practices and six hospital outpatient clinics to determine how a patient-centered diabetes consultation model affected the resulting intensity of diabetes care. They measured whether care became more intensive, did not change or changed minimally, or became less intensive after an annual consultation by asking clinicians to complete an online questionnaire that addressed monitoring frequency and referral to other clinicians and asked about the intended intensity of diabetes care over the next year. Possible responses were “more intensive in multiple aspects,” “more intensive in one specific aspect,” “no/minimal change,” “less intensive in one specific aspect,” or “less intensive in multiple aspects.” Clinicians were also asked whether they had set goals with the patient and were asked to choose three out of 20 factors that they believed were most important in determining the patient's care needs. Of these factors, 12 were person-related and eight were disease-related. The study results were published July 6 by Diabetic Medicine.

The question concerning the intensity of care was answered by physicians or nurses for 1,284 patients. A total of 22.8% reported that the patient chose more intensive care, 70.6% said the patient chose not to change care or changed it only minimally, and 6.6% said the patient chose less intensive care after the consultation. Patients were more likely to choose more intensive care if they had a high level of education (odds ratio [OR], 1.65; 95% CI, 1.07 to 2.53; P=0.023), if they were concerned about illness (OR, 1.08; 95% CI, 1.00 to 1.17; P=0.045), if they had set goals for their care (OR, 6.53; 95% CI, 3.79 to 11.27; P<0.001), and if they had comorbid conditions (OR, 1.12; 95% CI, 1.00 to 1.24; P=0.041). Patients who took oral blood glucose-lowering drugs were less likely to plan more intensive care (OR, 0.59; 95% CI, 0.39 to 0.89; P=0.011). In addition, patients with higher levels of diabetes distress were less likely to choose less intensive care (OR, 0.87; 95% CI, 0.79 to 0.97; P=0.009), and diabetes distress was the only factor that was statistically significant in the multivariable model. Clinicians cited six factors that most frequently determined care decisions: patients' quality of life, lifestyle, preferences, motivation, glycemic control, and self-management possibilities.

The researchers noted that their study was observational, that the question about intended intensity of care was subjective, and that no adjustments were made for multiple comparisons. They concluded that in their study, patients participating in shared decision making regarding diabetes chose to intensify care based on both patient-related and disease-related factors. Recognizing, evaluating, and managing signs of patient distress may be the best investment of time when developing a treatment plan, and setting goals seems to be the most important factor in predicting more intensive treatment, the authors said. “It is possible that people are more likely to set goals when they are frequently confronted with person- and/or health-related problems needing professional support compared to people whose care underwent no or minimal change,” they wrote.