Patient perceptions often diverge from T2D guidelines

  • Schoenborn NL & al.
  • JAMA Intern Med
  • 16.09.2019

  • von Craig Hicks
  • Clinical Essentials
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Takeaway

  • Many older patients with type 2 diabetes (T2D) do not place high importance on guideline-recommended factors for determining whether to start or stop use of diabetes medications.

Why this matters

  • Mistaken beliefs about guideline factors for individualizing glycemic targets could present substantial barriers to shared decision-making and contribute to inappropriate treatment goals and care, say researchers.

Study design

  • Researchers surveyed patients aged ≥65 years with T2D (N=818; mean age, 74.0±6.8 years; 57.3% men; 81.7% white), randomly assigning them to answer questions about either adding or removing medications from diabetes treatment plans.
  • Funding: NIH; American Cancer Society; American Heart Association; Bloomberg Philanthropies.

Key results

  • Patients rated the risk for adverse effects as the most important factor for either adding or stopping a medicine (relative importance on a ratio scale, 22.8 and 25.0, respectively).
  • Contrary to guideline recommendations, most patients believed more aggressive treatment was warranted for those with longer disease duration (60.1%), more established complications (77.3%), and a greater number of other health conditions (66.6%).

Limitations

  • Survey scenarios were hypothetical; responses may not fully reflect patient behaviors.
  • Results may not apply to some subgroups of older adults, such as those with low health literacy.