Division of Endocrinology and Metabolism, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
The Michener Institute of Education at UHN, 222 St. Patrick Street, Toronto, Ontario M5T 1V4, Canada.
Diabetes Res Clin Pract. 2019 Mar;149:89-97. doi: 10.1016/j.diabres.2019.01.020. Epub 2019 Jan 24.
To investigate experiences of people with type 2 diabetes (T2DM) at the clinic visit when an additional oral antidiabetes drug (OAD) is prescribed, and how this affects their quality of life, self-management and key outcomes.
We surveyed adults with T2DM from a large multinational study of patient-physician communication during early T2DM treatment (IntroDia®). We examined their experiences when an additional OAD is prescribed ("add-on") after initial OAD monotherapy, focusing on 24 key conversational elements, overall patient-perceived communication quality (PPCQ), and associations with current patient-reported outcomes. The links between PPCQ and people's efforts to delay add-on therapy were also assessed.
4235 people with T2DM prescribed an additional OAD, or a combination of two, were analysed. Exploratory factor analyses of the conversational elements during add-on yielded three coherent, meaningful factors: Encouraging (Cronbach's α = 0.62), Collaborative (α = 0.81), and Discouraging (α = 0.81). PPCQ was positively associated with Encouraging (β = +1.252, p < 0.001) and Collaborative (β = +1.206, p < 0.001), but negatively associated with Discouraging (β = -0.895, p < 0.001). Better PPCQ at add-on was associated with less diabetes distress, greater well-being and better self-care at the present time. Approximately 20% of people bargained (two-thirds successfully) with their physician to delay additional medication. Non-bargaining individuals reported significantly better mean PPCQ, diabetes distress, well-being and self-care than those who bargained.
Encouraging and patient-inclusive conversations at add-on moments may improve patient well-being and self-care outcomes. People with T2DM who attempted to delay additional medication reported poorer PPCQ and outcomes.
调查 2 型糖尿病（T2DM）患者在诊所就诊时增加口服降糖药（OAD）时的体验，以及这如何影响他们的生活质量、自我管理和关键结局。
我们调查了来自一项关于 2 型糖尿病患者早期治疗期间医患沟通的大型跨国研究（IntroDia®）的成年 T2DM 患者。我们检查了他们在初始 OAD 单药治疗后增加 OAD（“加用”）时的经历，重点关注 24 个关键对话要素、整体患者感知沟通质量（PPCQ），以及与当前患者报告结局的关联。还评估了 PPCQ 与人们延迟加用治疗努力之间的联系。
分析了 4235 名接受额外 OAD 或两种药物联合治疗的 T2DM 患者。对加用期间对话要素的探索性因子分析得出了三个一致且有意义的因素：鼓励（Cronbach's α=0.62）、协作（α=0.81）和劝阻（α=0.81）。PPCQ 与鼓励（β=+1.252，p<0.001）和协作（β=+1.206，p<0.001）呈正相关，与劝阻（β=−0.895，p<0.001）呈负相关。加用时更好的 PPCQ 与当前糖尿病困扰减少、幸福感提高和自我护理更好相关。大约 20%的患者与医生讨价还价（三分之二成功）以延迟额外药物治疗。与讨价还价的患者相比，不讨价还价的患者报告的 PPCQ、糖尿病困扰、幸福感和自我护理均显著更好。
在加用时刻进行鼓励和以患者为中心的对话可能会改善患者的幸福感和自我护理结局。试图延迟额外药物治疗的 T2DM 患者报告的 PPCQ 和结局较差。
