Understanding barriers to glycaemic control from the patient’s perspective

Abstract

INTRODUCTION: To better understand barriers to glycaemic control from the patient’s perspective. METHODS: An interpretative phenomenological approach was used to study the experiences of 15 adults with Type 2 diabetes. Participants each gave a semi-structured interview of their experiences of living with diabetes. Interviews were transcribed, and themes extracted and organised using a patient-centred framework. FINDINGS: Participants’ stories confirmed many of the barriers in the literature, particularly those related to context, such as family, finances, work. Barriers also related to negative emotional reactions to diabetes: fear of new events (diagnosis, starting pills/insulin); guilt about getting diabetes and not controlling it; and shame about having diabetes. Barriers also related to unscientific beliefs and personal beliefs. There were additional barriers related to poor clinician–patient relationships. Overall, participants had a poor understanding of diabetes, and complained that their clinician simply ‘told them what to do’. CONCLUSION: Using a patient-centred approach, this study identified many barriers to glycaemic control. We suggest that a key barrier is clinician ignorance of their patients’ fears, beliefs, expectations, context; of what constitutes a positive therapeutic relationship; and of the limitations of a biomedical approach to patient non-adherence. Faced with both a worsening diabetes epidemic and increasing health care workforce shortages, clinicians urgently need to understand that it is they, not their patients, who must change their approach if diabetes care is to be improved. KEYWORDS: Communication barriers; diabetes mellitus, type 2; medication adherence; patient-centered care

Understanding the physical, social, and emotional experiences of people with uncontrolled Type 2 diabetes: a qualitative study

“…A lack of adherence is a common problem in chronic pathologies such as diabetes, with public health and economic repercussions. A good physician-patient relationship and effective channels of communication, as well as shared decision making, are key to facilitating the patients’ understanding of their pathology and treatment 24,25. Knowledge of the reasons motivating patients to not follow the recommended lifestyle and pharmacological changes allows us to select strategies appropriate for each patient to improve their control of Type 2 diabetes 9,25…”

Viewpoint: Using the patient-centred medicine clinical framework to better appreciate and explore the many barriers to care in Type 2 diabetes

“…Fear or distress: The identified fear could be non-specific, such as fear of loss of control over their life, [14][15][16][17][18][19]37 or of potential future events (disease complications, 14,[22][23][24] and drug side effects 16,19,20,25,35,39 ). The fear could also be specific to events, such as glucose monitoring, 19,20,36 diagnosis, 18,21,22,24,29,37 starting oral medications, 16,18,19,36 starting insulin (including fear of insulin and needles), 16,[18][19][20][21]35,36,39 and fear of hypoglycaemia. 13,16,19 ii.…”

“…The fear could also be specific to events, such as glucose monitoring, 19,20,36 diagnosis, 18,21,22,24,29,37 starting oral medications, 16,18,19,36 starting insulin (including fear of insulin and needles), 16,[18][19][20][21]35,36,39 and fear of hypoglycaemia. 13,16,19 ii. Despair as a barrier: Feelings of despair were identified as a barrier to care in a number of studies.…”

“…Despair as a barrier: Feelings of despair were identified as a barrier to care in a number of studies. 14,18,19,21,23,24,34,39 iii. Guilt/self-blame: Patients frequently blamed themselves for poor diet/lifestyle as the cause of their diabetes and its poor control.…”

“…Guilt/self-blame: Patients frequently blamed themselves for poor diet/lifestyle as the cause of their diabetes and its poor control. 13,15,17,19,20,34,39 Understanding the disease requires history, examination, and investigation.…”