Expectations and fear of diabetes-related long-term complications in people with type 2 diabetes at primary care level

Kuniß, Nadine; M, Freyer; Müller, N; Kielstein, Volker; Müller, Ulrich

doi:10.1007/s00592-018-1217-9

Cited by 23 publications

(22 citation statements)

References 10 publications

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“…More than one third of the study participants showed significant fear of developing long-term complications. These results are in line with a previous study by Kuniss et al (2018) supporting that the prevalence of diabetes-related long-term complications was overestimated by people with DM2 at primary care level [10].…”

Section: Discussionsupporting

confidence: 93%

“…However, concrete numbers regarding prevalence and risks of these complications are not communicated within these programmes. A previous study by Kuniss et al (2018) showed that prevalence of diabetes-related long-term complications were overestimated by people with DM2 at primary care level, and approximately one third of the participants showed elevated fear of complications [10]. The trial by Meltzer et al (2000) confirmed this overestimation in people with DM1 [11].…”

Section: Introductionmentioning

confidence: 96%

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Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes

Arend

Müller

Schmitt

et al. 2019

Exp Clin Endocrinol Diabetes

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Objective The quality report of the disease management programmes of North Rhine Westphalia 2016 showed prevalences for long-term complications (neuropathy, nephropathy, retinopathy) of less than 30% for people with diabetes type 1 (DM1) and type 2 (DM2). The aim of this study was to assess risk expectations and fear regarding long-term complications of diabetes in people with DM1 and DM2. Methods We assessed risk expectations and fear regarding diabetes complications in people with DM1 (n=110) and DM2 (n=143 without insulin, n=249 with insulin) visiting an University outpatient department of metabolic diseases. Fear of long-term complications was measured with the “Fear of Complications Questionnaire (FCQ)” (range 0–45 points, scores ≥30 suggest elevated fear). Participants were asked to estimate general and personal risks of long-term complications 10 years after developing diabetes in %. Results Elevated fear of complications (FCQ scores ≥30) was observed in 34.5, 25.9, and 43.0% of those with DM1, DM2 without insulin and DM2 with insulin, respectively. Participants estimated a mean general risk of diabetes-related complications after 10 years amounting to 45.9±15.8% (DM1), 49.7±15.4% (DM2 without insulin), and 52.5±16.4% (DM2 with insulin) and personal risk with 52.5±24.4% (DM1), 45.8±22.7% (DM2 without insulin), and 54.1±23.4% (DM2 with insulin), respectively. Higher risk expectations were associated with higher fear of complications (p<0.001). Conclusion Risk estimations regarding long-term complications were exaggerated in people with DM1 and DM2. About one third of the participants reported elevated fear of complications. Participants’ risk expectations and fear regarding diabetes complications appear excessive compared to population-based prevalence rates.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 96%

Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes

Arend

Müller

Schmitt

et al. 2019

Exp Clin Endocrinol Diabetes

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“…And, while fear-based messages can be motivating, they may not be ideally suited for promoting positive diabetes-related behavior changes [32]. First, there may be limits to the level of fear that is motivating, and past work has demonstrated many individuals already fear disease-related complications and actually overestimate their risk for these outcomes [33][34][35][36]. Also, for fear to effectively shift behaviors, individuals need to know what actions to take to prevent the feared outcomes, information that was not included with the tested formats [33].…”

Section: Discussionmentioning

confidence: 99%

Testing patient-informed approaches for visually depicting the hemoglobin A1c value to patients with poorly controlled diabetes: a randomized, controlled trial

Gopalan

Suttner

Troxel

et al. 2020

BMC Health Serv Res

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Background: Patients' understanding of the hemoglobin A1c (HbA1c) has been linked to better diabetes care outcomes (glycemic control, self-care). This is concerning given low documented rates of HbA1c understanding. In this non-blinded, randomized trial, we compared two formats for communicating the HbA1c, selected based on input from people with diabetes, to standard presentation to assess their impact on participants' glycemic control and diabetes-related perceptions.Methods: To design the tested formats, we interviewed 25 patients with diabetes and reviewed a range of possible formats, including color-based scales and graphs. The interviews were recorded, transcribed, and subjected to thematic analysis. Synthesizing interviewees' feedback, we selected two formats, one using a combination of words and colors (Words) and one using a color-coded graph (Graph), for further evaluation. We then randomized adults with poorly controlled diabetes to receive mailed information on their current diabetes control in one of three ways: 1) standard lab report (control), 2) Words format, or 3) Graph format. The primary outcome was HbA1c change at 6 months. Also examined were changes in participants' diabetes-related perceptions and choice of participation incentive. Results: Of the 234 enrolled participants, 76.9% were Black, and their median baseline HbA1c was 9.1% (interquartile range 8.4-10.4). There were no between-arm differences in HbA1c change (− 1.04% [SD 2.2] Control vs. -0.59% [SD 2.0] Words vs. -0.54% [SD 2.1] Graph, p > 0.05 for all comparisons). Participants in the Words arm had an increase in the accuracy of their perceptions of diabetes seriousness (p = 0.04) and in the number of participants reporting a diabetes management goal (p = 0.01). Conclusions:The two patient-informed communication formats did not differentially impact glycemic control among adults with inadequately controlled diabetes. However, a significant proportion of participants in the Words arm had an increase in the accuracy of their perception of diabetes seriousness, a potential mediating factor in positive diabetes-related behavioral changes. With increasing use of patient-facing online portals, thoughtfully designed approaches for visually communicating essential, but poorly understood, information like the HbA1c to patients have the potential to facilitate interpretation and support self-management.Clinical trial registration: Prospectively registered as NCT01886170.

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“…In Netherlands, people with T2DM and cardiovascular diseases follow a cognitive behavioral program aimed at modifying dietary behavior, physical activity, smoking behavior and its used methods as motivational interviewing and problems solving treatment focusing on intrinsic motivation for change and self-management 52 . The absolute risk of diabetes -related long -term complications (neuropathy, nephropathy, retinopathy, amputation, dialysis, blindness, stroke, coronary sclerosis) is not communicated and therefore often overestimated by patients, public health media, and health care professionals 53 . The study carried out in the United Arab Emirates (n = 490) reported that the prevalence of T2DM was 23% with hypertension, obesity, and dyslipidemia being the most common T2DM comorbidities and found that levels of estimated glomerular filtration rate and disease duration were the most significant risk factors for the development of complications 54 .…”

Section: Discussionmentioning

confidence: 99%

Untitled

Budrevičiūtė¹,

Kalèdiené²,

Paukštaitienė³

et al. 2019

SPV

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Background. Type 2 diabetes mellitus (T2DM) is a complex disease that leads to continuous medical care with comprehensive, multifactorial strategies for reducing disease risk for patients. There is an ongoing discussion on how to better manage chronic diseases at primary health care facility level. It is recognized that continuous management of chronic diseases needs to find new ways in managing risk and outcomes of chronic diseases. Aim of the study. To find the elements of value creation management with perspectives of priorities management and to examine the impact of factors on chronic diseases state with prognosis of T2DM progress in primary health care. Sveikatos politika ir valdymas Materials and methods. The methods of the research were based on the group discussions of managers from primary health care and the survey of patients with T2DM that was conducted after the consultation of family doctor in primary health care facilities in Lithuania. Focus group discussions (n = 48) were conducted from May 2015 to March 2016 in 10 counties of Lithuania (31 executives of public primary health care facilities and 17 executives of private primary health care facilities). From October 2017 to January 2018, the survey of patients (n = 510) with T2DM was conducted (258 from public and 252 from primary health care facilities). Multinomial logistic regression was used for the analysis. Results. The main elements of value management with focus on chronic diseases management were health promotion, quality of life, time management, satisfaction, communication, partnership with health care professionals, values and lifestyle of patients. Significant distribution among sociodemographic (income, place of residence, gender), non-clinical (affiliation to primary health care facility, self-perceived health, satisfaction with T2DM treatment, treatment options) factors were investigated. Age, gender, place of residence, self-perceived health, education, treatment options of T2DM were the factors that predicts the prognosis of T2DM progress. Conclusions. The foundation of value elements with perspectives of priorities management provides insights to develop interventions programs and projects that would increase patient satisfaction with primary health care services. The factors evaluation on T2DM progress is the opportunity to find effective management tools that helps predict a disease evolution. The prediction of T2DM is basis for clinicians and managers in priorities setting and decision making. The results of the research can be ground for the continuous management of T2DM disease improvement in primary health care facility. The determination of elements of value management, the distribution of factors among T2DM disease states, the factors examination on chronic diseases states can be the principles of building theories.

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Expectations and fear of diabetes-related long-term complications in people with type 2 diabetes at primary care level

Cited by 23 publications

References 10 publications

Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes

Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes

Testing patient-informed approaches for visually depicting the hemoglobin A1c value to patients with poorly controlled diabetes: a randomized, controlled trial

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