Physician-patient communication at prescription of an additional oral drug for type 2 diabetes and its links to patient outcomes – New findings from the global IntroDia® study

Authors: Edelman S, Belton A, Down S, Alzaid A, Capehorn M, Gamerman V, Nagel F, Lee J, Emmerson J, Polonsky WH.

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Source: https://pubmed.ncbi.nlm.nih.gov/30685350/

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BDI Monthly Events

March 12Case Consultation Meeting
March 12: BDI hosts the San Diego-wide, monthly case consultation meeting (for mental health professionals working in the field of diabetes). Contact us at [email protected] if you are in the greater San Diego area and would like further information about this program.
March 19-22International Conference
18th International Conference for ATTD (Advanced Technologies and Treatments for Diabetes) in Amsterdam, Dr. Polonsky (BDI President) has three presentations.
March 19Type 2 Presentation
On March 19, Dr. Polonski will present CGM is Wonderful, But… at the Roche-sponsored symposium, “Translating the Power of Prediction into Diabetes Management”, and Insulin Therapy Experience: Considering the Needs of People Living with Diabetes (with Professor Cukierman-Yaffe) at the Sanofi-sponsored symposium, Confidence and Simplicity in Diabetes Management”. https://attd.kenes.com/
March 20Type 2 Presentation
On March 20, Dr. Polonski will present Improved Patient- and Physician-Reported Outcomes with IGlarLixi When Switching From Premixed Insulin in People with Type 2 Diabetes: The Soli-Switch Study. https://cslide.ctimeetingtech.com/attd25/attendee/confcal/session/calendar/2025-03-20