Rahul Khairnar1, Khalid M Kamal2, Vincent Giannetti3, Nilanjana Dwibedi4, Jamie McConaha5. 1. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, USA. 2. School of Pharmacy, Pharmaceutical, Administrative and Social Sciences, Duquesne University, USA. Electronic address: kamalk@duq.edu. 3. School of Pharmacy, Pharmaceutical, Administrative and Social Sciences, Duquesne University, USA. 4. Pharmaceutical Systems and Policy, West Virginia University, USA. 5. Pharmacy Practice, School of Pharmacy, Duquesne University, USA.
Abstract
BACKGROUND: Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. OBJECTIVE: To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. METHODS: This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having ≥2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels: <7, 7-9, and >9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted. RESULTS: A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years ( ±11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X2 = 15.73, p < 0.01), insurance status (X2 = 12.03, p < 0.05), referral to an endocrinologist (X2 = 6.17, p < 0.05), level of self-management (X2 = 12.01, p < 0.05) and willingness to use insulin (X2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X2 = 33.04, p < 0.01) and referral to an endocrinologist (X2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and 'less than graduate level' education were significant predictors of glycemic stability. CONCLUSIONS: Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.
BACKGROUND:Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. OBJECTIVE: To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. METHODS: This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having ≥2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels: <7, 7-9, and >9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted. RESULTS: A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years ( ±11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X2 = 15.73, p < 0.01), insurance status (X2 = 12.03, p < 0.05), referral to an endocrinologist (X2 = 6.17, p < 0.05), level of self-management (X2 = 12.01, p < 0.05) and willingness to use insulin (X2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X2 = 33.04, p < 0.01) and referral to an endocrinologist (X2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and 'less than graduate level' education were significant predictors of glycemic stability. CONCLUSIONS: Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.