Cath Lab Digest

Given that patients with diabetes can face extensive treatments due to the risk of complications, adherence to treatment regimens may be a problem due to a perceived decline in their quality of life.

A new study finds that although end-stage complications have the greatest effect on quality of life, comprehensive treatments affect quality of life to the degree that some patients were willing to forego years of healthy living to avoid treatments.

In the study, which was recently published in Diabetes Care, researchers interviewed 701 patients with diabetes and evaluated nine disease complications and 10 treatment states. Researchers asked patients not to consider the treatments’ long-term effects on complications but to concentrate on the treatments’ daily effects on quality of life. The study notes that researchers also questioned patients on their perceptions of their quality of life with comprehensive diabetes care, which the study authors described as cholesterol-lowering medication, aspirin, intensive blood pressure control, intensive glucose control, diet and exercise.

Twelve to 50 percent of patients said they would give up eight of 10 years of perfect health to avoid life with complications, according to the study. In addition, 10 to 18 percent of patients said they would sacrifice eight of 10 years of life in perfect health to avoid a life with treatments.

Recognizing The Challenges Of Changing Patient Perspectives
The study notes that DPMs may educate patients early in the disease course to allay their concerns “about the true nature of optimal diabetes care by incorporating their preferences into treatment decisions, and by acknowledging patient preferences and quality of life concerns in public health efforts to improve the quality of diabetes care.”

Matthew Claxton, DPM, notes the challenge of improving patient perspectives on diabetes. He says most have had bad family experiences with the disease as they may have had parents or grandparents lose their eyes, kidney function or limbs.

“If we are to effectively treat diabetics with the ‘team’ mentality, then each team member must be responsible for giving hope,” says Dr. Claxton, who is in private practice in Belleville, Ill. However, he does note that sometimes he has to explain to the patient what other members of the multidisciplinary care team should have explained.

At an initial visit, Dr. Claxton says he will spend 20 to 30 minutes helping patients understand their diet and why they are receiving referrals to multiple doctors. He also encourages patients to recognize that diabetes should not control their lives and emphasizes that diet and exercise are not punishments but goals for healthy living. Dr. Claxton says this approach has been successful in facilitating a positive mental attitude as these patients “are very happy and continue to improve their control of diet and exercise.”

As far as the importance of education goes, lead study author Elbert Huang, MD, MPH, emphasizes involving patients with self-management so they can take ownership of their diabetes. He also advocates prioritizing different aspects of care so patients can win small battles.

“If a patient is willing to take an aspirin or an ACE inhibitor, that is a form of success even if the patient continues to resist other treatments,” says Dr. Huang, an Assistant Professor of Medicine at the University of Chicago.

Dr. Huang also relates the idea of shared decision-making, which involves education as well as DPMs being sensitive to patients’ treatment preferences. He says advocates of the technique ensure that patients understand their decisions and if patients choose not to take a medicine, it is their choice.

“We have to take a step back sometimes to realize that our patients do not need to be frightened or threatened into compliance, but encouraged,” points out Dr. Claxton.

He wonders whether patients in the study were polled on the negative comments doctors may have given them regarding self-management of their diabetes.