Addressing Treatment Burden in Diabetes

The practice of evidence-based medicine can be especially challenging when managing patients with diabetes. Patients’ care needs are frequently discussed in routine clinical encounters, but little is known about how patients feel about their burden of treatment (BOT) or if conversations on this topic occur with regularity. In addition, BOT can be interpreted differently by healthcare providers and patients. Issues with BOT may lead providers to intensifying treatments for patients so that they achieve therapeutic targets. Patients, on the other hand, may view BOT more in the context of problems with access to care, side effects, or daily self-care demands. Intriguing New Data on Diabetes Treatment Burden In the January 2012 issue of Diabetes Care, my colleagues and I analyzed videos of primary care encounters between patients with type 2 diabetes and clinicians. Our objective was to see if patients with type 2 diabetes and their clinicians discussed BOT, the characteristics of these discussions, and attempts to address and reduce BOT during visits. Two coders independently reviewed videos of primary care visits from patients with type 2 diabetes. Verbalizations concerning BOT were identified and then classified by topic and by whether BOT was addressed. Of the 46 visits analyzed, 43 (93.5%) contained BOT discussions. BOT was explicitly addressed only 30% of the time by clinicians, even though patients initiated 55% of the BOT discussions observed in the analysis. Our results suggest that patients with diabetes routinely discuss BOT with clinicians, but often with no effect. Access to care was prevalently addressed, but administration and monitoring were largely unaddressed. This finding suggests that there may be concern among patients about...