Memorandum

Adults with type 2 diabetes far more willing to achieve A1c targets earlier than providers perceive, according to unsettling AACE survey – July 27, 2016

Executive Highlights

  • Survey indicates that 55% of adults with type 2 diabetes would increase their efforts to achieve A1c targets more quickly, while only 18% of healthcare professionals believe in this patient willingness.
  • Data highlights the value of personalized, patient-centric approaches to diabetes treatment and management.

The American Association of Clinical Endocrinologists (AACE) recently released findings from its two-part “Perspectives in Diabetes Care” online survey, a study sponsored by Sanofi. Results show a major and very unsettling discrepancy between patient willingness to accelerate their diabetes care and healthcare providers’ beliefs regarding their patients’ willingness to commit. Ugh! Of 1,000 adults living with type 2 diabetes for one to five years, 55% reported willingness to do more to achieve their A1c goals faster by increasing doctor’s visits and/or altering medications. Meanwhile, only 18% of endocrinologists, primary care physicians, and other medical professionals (n=1,004) believed that adults with type 2 diabetes would make such efforts. More specifically, 57% of adults with type 2 diabetes said they would visit a healthcare provider more frequently, compared to 19% of providers believing their patients would do so (what!); 52% of patients said that they were “very willing to make multiple medication changes,” while only 16% of providers perceived this patient willingness to adjust medication regimen. We expect part of it may be HCPs don’t have time? The system is certainly suboptimal for encouraging in-depth conversations – there could be, of course, some patient statement bias.  

This stark contrast between patient and provider perspective supports the increasing frustration that patients experience throughout diabetes treatment and management. Of the 22% of individuals who discontinued their diabetes medication before contacting their providers, 38% reported doing so because they had not achieved desired A1c levels as swiftly as expected. The impact of not achieving one’s A1c goals can have a huge effect on overall health as well as quality of life, with seven out of 10 people who had not reached target A1c levels experienced declines in emotional wellbeing. These statistics underscore the immense value of collaboration and communication between patients, families, and healthcare providers in treating diabetes. We hope these data implore healthcare providers to recognize that patients starting treatment for type 2 diabetes may have varied expectations for the time it will take to achieve A1c goals, and that it is import to address concerns when they arise. To this end, we should consider a range of personalized treatment options to meet the needs of individuals, with some requiring more aggressive early measures toward glycemic control. Critically, we should set clear expectations for time-to-target A1c to avoid patient discouragement.

  • The renowned Dr. George Grunberger (Wayne State University, Bloomfield Hills, MI), recent president of AACE, encourages providers to individualize type 2 diabetes management in line with AACE guidelines. As he points out, “knowing from the survey findings that adults living with type 2 diabetes are willing to do more to achieve their individualized A1C target quicker, physicians should feel empowered to engage in a dialogue with patients to understand their expectations and identify the most appropriate diabetes management approach for them. The AACE diabetes guidelines and algorithm, which recommend re-evaluating patients every three months, can serve as a reference for physicians to help close this gap in perception.” As recommended by AACE, patients should be re-evaluation every three months and treatment intensified as needed in the absence of target achievement. 
  • The highly regarded Dr. Steve Edelman (UCSD/TCOYD, San Diego, CA) urged healthcare providers to have more empathy and compassion for those living with type 2 diabetes. Rather than assume people with type 2 diabetes are lazy and do not want to live a long and healthy life, healthcare providers should consider the whole person, according to Dr. Edelman, and recognize how complicated it is to manage type 2 diabetes, a sentiment shared by Dr. William Polonsky (Behavioral Diabetes Institute, San Diego, CA). Healthcare providers must acknowledge the obstacles that prevent patients from being adherent to type 2 diabetes medications, and find caring and creative ways to help their patients manage diabetes successfully according to the two diabetes experts. 
  • Subgroup analyses revealed important differences between those who had (n=582) and had not (n=418) achieved their A1c goals when taking the survey. Notably, 72% of those who had not yet achieved their optimal glycemic control expressed frustration, while 33% of those who had reached their A1c target reported experiencing frustration at at least one point during their course of treatment. There were no significant associations between A1c target achievement and race, age, geographic location, or age of diagnosis.

Table 1: Major “Perspectives in Diabetes Care” AACE Survey Results

 

Willing to visit HCP more often

Willing to make more medication changes

Experienced frustration

Achieved A1c (n=582)

60%

53%

33%

Not Achieved A1c (n=418)

54%

52%

72%

  • We were also reminded of Dr. Anne Peters’ (Keck School of Medicine, Los Angeles, CA) commentary at ADA about the need for cognitive behavioral therapists in diabetes care. Dr. Peters emphasized at the 10th annual TCOYD/The diaTribe Foundation forum that the field strongly needs cognitive behavioral therapists as allies in treating diabetes to help set realistic expectations and to help motivate patients toward them. This would assume, of course, that there was reimbursement in the system and no other major system problems – hard to imagine, of course. The recent results from the AACE survey reflect this same theme, and we hope these findings translate into noticeable improvements in diabetes care.

-- by Lucy Chu, Payal Marathe, Sarah Odeh, and Kelly Close