Treatment approach key in diabetes self-management
Study focuses on psychosocial factors
Diabetes is a disorder requiring significant self-management by patients, and the organization of the health care system has a great effect on how patients manage the condition, according to research presented recently at the 62nd annual meeting of the Alexandria, VA-based American Diabetes Association.
The findings suggest that more effective organization of factors related to the health care system can improve the physical and psychological well-being of people with diabetes, says Richard Rubin, PhD, lead author of the presentation and associate professor of medicine and pediatrics at the Johns Hopkins University School of Medicine in Baltimore and a member of the International DAWN Advisory Panel. "Diabetes is a lifelong condition and requires lifelong management to reduce the risk of complications," he says.
"Our findings show that among many factors — including patient age, sex, and beliefs about diabetes, and the type and duration of the diabetes — it’s the health care system’s organization and accessibility that are the most powerful predictors of successful management," Rubin adds.
Other findings presented at the meeting show that while diabetes care providers recognize the importance of psychological problems in their patients and devote significant efforts to addressing them, many providers have insufficient resources to deal with them. Both studies were part of a larger international study called DAWN (diabetes attitudes, wishes, and needs), the largest global psychosocial diabetes survey of its kind ever conducted. The full DAWN study addresses the perceptions and attitudes of more than 5,000 people with diabetes and 3,000 diabetes health care professionals in 13 countries.
The study on factors affecting diabetes management was based on a DAWN study subsample of 500 U.S. patients. For each patient, the researchers assessed, as key outcomes, self-reported indicators of successful diabetes management, including: adherence to recommendations for diet, exercise, and self-monitoring of blood glucose; blood-glucose control; and psychosocial adjustment to the disorder. The researchers also assessed possible predictors of these outcomes, including the patient’s gender, age, and duration of diabetes; and relevant health care system organizational factors such as accessibility of providers, patients’ relationship with their primary care provider, availability of the health care team, communication among providers, patient belief that health care providers are primarily responsible for diabetes management, and patient belief that diabetes care is burdensome and complicated.
The researchers found that organizational factors related to the health care system were the strongest predictors of successful management. Examples of specific findings include:
- Accessibility of health care providers predicted all outcomes except adherence to self-monitoring of blood glucose.
- The patient’s relationship with the primary provider predicted blood glucose control and psychosocial adjustment.
- The availability of team care predicted blood glucose control.
- Communication among providers predicted patient adherence to exercise recommendations.
- Patient belief that providers have primary responsibility for diabetes care predicted diet adherence but worse psychosocial adjustment.
- Patient belief that diabetes care is burdensome also predicted worse outcomes in terms of psychosocial adjustment, blood glucose control, and diet adherence.
"Clearly, effective organization of health care resources can enhance patient physical and psychological well-being," Rubin says. "In particular, ensuring patient access to the health care team and communication among team members with each other and with the patient can go a long way."
"There is an important psychosocial side to diabetes and its treatment that must be addressed, but many care providers have insufficient skills, time, and/or resources to do so," says Mark Peyrot, PhD, lead author of the study and professor of sociology at Loyola College in Baltimore.
"Our findings suggest that training diabetes care providers in the recognition, treatment, and referral of patients with psychosocial needs could make a major contribution to the quality of their care."
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