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Poor insulin adherence tied to dissatisfying interactions with physicians
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Insulin adherence in adults with type 2 diabetes was negatively affected by diabetes-related distress and dissatisfaction with physician interactions, according to recently published findings.
Bruno Linetzky, MD, of Eli Lilly and Company in Buenos Aires, Argentina, and colleagues evaluated data from the 2-year prospective MOSAIC study on 4,341 adults (mean age, 61.8 years; 50% women) with type 2 diabetes (duration, 12.7 years; mean baseline HbA1c, 8.1%) to determine how the patient–physician relationship correlates with diabetes-related distress, insulin adherence and glycemic control.
Participants completed the interpersonal processes of care survey and the diabetes distress scale to measure perception of physician interactions, diabetes-related distress level and insulin adherence.
Six domains were assessed from the interpersonal processes of care survey:
- hurried communication, which evaluated communication from the physicians;
- explained results, which evaluated the extent to which physicians explained test results;
- decision making, which evaluated how willing physicians were to listen to patient concerns about treatments;
- compassionate/respectful, which evaluated how a physician responded to a patient’s concern; and
- discrimination, which evaluated how a physician reacted to a patient.
Greater diabetes-related distress was independently correlated with high scores in the hurried communication and discrimination domains, whereas high scores in the explained results and patient-centered decision-making domains were correlated with lower diabetes-related distress. The hurried communication domain was more strongly related to diabetes-related distress compared with the other domains (P < .001).
Independent associations were found between a greater likelihood of missed insulin injections and higher scores on the hurried communication domain (adjusted OR = 1.35; 95% CI, 1.2-1.53) and the discrimination domain (adjusted OR = 1.13; 95% CI, 1.02-1.27), a lower score on the explained results domain (adjusted OR = 0.86; 95% CI, 0.77-0.97) and greater diabetes-related distress (adjusted OR = 1.14; 95% CI, 1.06-1.22).
There were independent associations between higher HbA1c level and diabetes-related distress (P < .01), hurried communication domain (P < .041) and poor insulin adherence (P < .001).
Poor insulin adherence correlated with a 0.43% increase in HbA1c, and a single-unit increase in diabetes-related distress and hurried communication domains were associated with a 0.171% and 0.145% increase in HbA1c, respectively.
“The findings of the present study point to a clear relationship between diabetes-related distress and aspects of patient–physician interactions with insulin adherence in patients with [type 2 diabetes],” the researchers wrote. “Patients’ perceptions of physician engagement and attentiveness, the quality of explanation about medical tests and their results, and discussion around the prescribed treatment regimen were directly associated with insulin adherence behavior. Diabetes-related distress and physician engagement and attentiveness were also shown to be independently linked to long-term glycemic control.” – by Amber Cox
Disclosure: Linetzky reports being an employee of Eli Lilly and Company. Please see the full study for a list of all other authors’ relevant financial disclosures.
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