Factors influencing intended intensity of diabetes care highlighted
medwireNews: Decisions about future intensity of care made during a person-centered type 2 diabetes consultation depend on both disease- and patient-related factors, report researchers from the Netherlands.
“Diabetes care organizations often state that a person’s preferences, needs, values and self-management possibilities should be taken into account by care providers,” write Heidi van Vugt (Utrecht University, the Netherlands) and co-authors in Diabetic Medicine.
“This type of approach is likely to improve the efficiency of diabetes care, for example, by increasing adherence to therapy,” they add.
With this in mind, the Dutch Diabetes Federation introduced a consultation model which includes shared decision-making, similar to the ADA/EASD decision cycle for person-centered glycemic management.
In the current study, van Vugt and team investigated how the introduction of the model affected the intended intensity of type 2 diabetes care using data from 1284 people assessed at 47 general practices and six hospital outpatient clinics across the Netherlands.
The consultation involved four steps, including an initial discussion about disease- and patient-related factors such as glycemic control and illness perception, followed by personalized goal-setting, a discussion of treatment options, and finally a decision about the type and extent of professional diabetes care for the coming year.
Following the consultation, 22.8% of people planned more intensive care in the coming year, 6.6% chose less intensive care, and the remaining 70.6% planned minimal or no change in their level of care.
After adjustment for potential confounders, the likelihood of people choosing to increase their intensity of care rather than keep it unchanged or minimally unchanged was significantly increased by having a care provider who set goals with the patient (odds ratio [OR]=6.53), a high education level (OR=1.65), comorbidity (OR=1.12), or concern about illness (OR=1.08).
By contrast, the use of oral blood glucose-lowering medication was associated with a significantly lower likelihood for increasing the intensity of care (OR=0.59).
Choosing less intensive care was associated with diabetes distress levels, such that individuals with the lowest diabetes distress level were more likely to choose less intensive diabetes care in the year after the consultation (OR=0.87).
In addition to the patient factors assessed, the investigators also asked the care providers to select three out of 20 variables that they believed most frequently determined the intended care.
The most commonly selected determinants by the care providers were quality of life, lifestyle, person’s preferences and motivation, glycemic control, and self‐management possibilities.
Van Vugt et al conclude that their study “supports the global plea for person-centred diabetes care, with the necessary emphasis on factors such as illness perception, personal wishes and preferences, diabetes distress and social support, all of which are evidence-based factors influencing diabetes self-management.”
By Laura Cowen
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