Contacting dropouts from type 2 diabetes care in public primary health care: description of the patient population

Triggers of treatment interruption and resumption among individuals with type 2 diabetes: a narrative cross-sectional qualitative study

PURPOSE

Treatment interruption and resumption are common among people with type 2 diabetes mellitus (T2D), but the triggers of resumption, according to the reasons for interruption, remain underexplored. This study examined patterns of treatment interruption and resumption.

METHODS

Narratives from 13 T2D patients with a history of treatment interruption were analysed through semi-structured interviews.

RESULTS

Four patterns were identified: 1) "Economic rationality", where financial barriers caused interruptions, but resumption was facilitated by low-cost check-ups and updated patient mindsets to manage medical expenses within the constraints of a limited household budget; 2) "Proactive information seeking", where doubts about treatment effectiveness led to interruptions, followed by resumption through active health risk reassessment by the patient's self-directed efforts; 3) "Health professional-patient relationship", where conflicts with healthcare providers prompted interruptions, but trustful encounters encouraged resumption; and 4) "Sustained partnerships with community health professionals", where personal challenges caused interruptions, but non-coercive partnerships with community health professionals fostered resumption through strengthened patient commitment.

CONCLUSION

This study highlights the need for tailored medical support and local policy development for T2D patients, emphasizing subjective interpretations of their experiences on treatment interruption and resumption. Recognizing these patterns can guide resource allocation and the design of community-based diabetes care interventions.

Perceived Future Outcomes of Unsuccessful Treatment and Their Association with Treatment Persistence Among Type-2 Diabetes Patients: A Cross-Sectional Content Analysis

INTRODUCTION

Despite the known strong association between patients' knowledge of outcomes of type 2 diabetes mellitus (T2DM) and treatment persistence, this knowledge in this patient population requires further clarification. The aim of our study was to reveal the perception of unsuccessful treatment outcomes among patients with T2DM and its association with treatment persistence by analysing answers to open-ended questions.

METHODS

In this cross-sectional study, 106 patients with T2DM who lived in Fukushima Prefecture, Japan, had a medical record in the Fukushima National Health Insurance Organisation database and had no cognitive problems were enrolled by purposive sampling. Treatment status was defined as "non-persistent" when a participant's treatment medical record was absent for a continuous period of ≥ 6 months; otherwise, it was referred to as "persistent". We asked about the possible future problems of untreated T2DM, inductively classified the open answers into 15 codes and then statistically examined the association between these codes and treatment persistence using logistic regression analysis adjusted for age and sex.

RESULTS

Persistent treatment was prevalent among participants who mentioned the code "treatment", which encompasses the terms that indicated invasiveness, such as dialysis, insulin injection, and shots (odds ratio 4.339; 95% confidence interval 1.104-17.055).

CONCLUSION

Persistent treatment was prevalent among patients with T2DM who mentioned the code "treatment", suggesting that these patients may anticipate a threat due to the invasiveness of diabetes and thus participate in persistent treatment to avoid this threat. Healthcare professionals should provide appropriate information and supportive conditions to achieve both a reduced feeling of threat and persistent treatment engagement.

Factors associated with the degree of glycemic deterioration among patients with type 2 diabetes who dropped out of diabetes care: A longitudinal analysis using medical claims and health checkup data in Japan

AIMS/INTRODUCTION

To identify factors associated with worsening glycemic control after discontinuing diabetes care among patients with type 2 diabetes.

MATERIALS AND METHODS

This retrospective cohort study combined medical claims and health checkup data between January 2005 and April 2018. Adult Japanese workers with type 2 diabetes who had dropped out from diabetes care for ≥4 months after receiving ≥18 months of non-intermittent care and had health checkup information both before and after the dropout were included. Factors associated with changes in HbA1c during the dropout period were identified using multiple linear regression analyses and depicting restricted cubic spline (RCS) curves.

RESULTS

A total of 1,125 patients (mean age: 51.2 years, baseline HbA1c: 6.8%, and number of males: 93.7%) whose follow-up HbA1c increased to 7.6% after a mean 9.3-month dropout period were included. Deterioration in HbA1c was associated with higher baseline HbA1c and sulfonylurea or insulin use. The RCS curves illustrated that patients without antidiabetic medication had small changes in HbA1c (+0.5% from a baseline HbA1c of 7.0%), whereas those using sulfonylureas or insulin had an approximately 2% or more increase in HbA1c even when maintaining reasonable glycemic control before dropping out.

CONCLUSIONS

Overall in this study, glycemic control worsened during treatment interruptions among patients who were mainly male employees. However, changes in HbA1c greatly varied based on baseline HbA1c and antidiabetic medication type. Caring for patients at risk of worsening glycemic control due to treatment dropout, especially those using sulfonylurea and insulin, is imperative.

A longitudinal follow-up study of a type 2 diabetes "lost to follow-up" cohort - positive effect on glycaemic control after changes in medication

The aim of this study was to evaluate whether patients with type 2 diabetes (T2D) who had stopped attending their diabetes treatment system (referred to as "lost to follow-up", LTF) but who succeeded in improving their glycaemic control after returning to the diabetes treatment system had changes in their diabetes medication when compared with similar patients who did not show improvement. "LTFs" who had baseline haemoglobin A_1 c (HbA_1 c) ≥53 mmol/mol and succeeded in reducing HbA_1 c ≥ 6 mmol/mol during a 12-30 month follow-up period after adhering again to their diabetes treatment system were compared with "LTFs" who had an unsatisfactory change in HbA_1 c or with "LTFs" who maintained good glycaemic control throughout the 12-30 month follow-up period. Unsatisfactory change in HbA_1 c was determined as HbA_1 c ≥ 53 mmol/mol and change <6 mmol/mol after the 12-30 month follow-up period in their diabetes treatment system or HbA_1 c < 53 mmol/mol when returning to the diabetes treatment system but ≥53 mmol/mol at the end of the 12-30 month follow-up period. "LTFs" with improvement in glycaemic control used a higher number of different anti-hyperglycaemic agents (P < 0.001) and their dosages of metformin increased (P < 0.05) when compared with "LTFs" without improvement or "LTFs" with satisfactory glycaemic control. Cholesterol-, LDL-cholesterol- and triglyceride-concentrations decreased during the 12-30 month follow-up period (P < 0.05) in "LTFs" with improved glycaemic control, but not in the other groups. "LTFs" with T2D who had poor glycaemic control seemed to require an increase in their anti-diabetic medication when attempting to improve their glycaemic control.

Relationship between number of contacts between previous dropouts with type 2 diabetes and health care professionals on glycaemic control: A cohort study in public primary health care

AIM

Previous study findings have shown that more frequent contacts with the diabetes care team predict better diabetes control. It is unknown whether this is true also for previous dropouts with type 2 diabetes (T2D). The aim of this study was to evaluate if those previous dropouts with T2D who succeeded to improve their glycaemic control had more frequent contacts with health care professionals in the public primary diabetes health care system than those dropouts who did not show improvement.

METHODS

In this "real life" retrospective cohort study, we identified 115 dropouts with T2D who were contacted by trained diabetes nurses and who returned to a public T2D-care system. Those previous dropouts who had baseline haemoglobin A_1c ≥53mmol/mol (7%) and had a reduction in HbA_1c≥6mmol/mol (0.5%) during the follow-up were compared with those with unsatisfactory change in HbA_1c (baseline HbA_1c≥53mmol/mol and change <6mmol/mol, or HbA_1c<53mmol/mol at the baseline measurement but above that in the end of the study period) or with those who remained at good glycaemic control over the study period. Trained diabetes nurses collected quantitative data from the patient records about visits and contacts during the follow-up.

RESULTS

Previous dropouts showing improvement had more visits to the diabetes nurse (p=0.003) and other nurses (p<0.001) than those with no improvement or those with satisfactory glycaemic control. Telephone calls not focusing on diabetes (p<0.001) were also more frequent among previous dropouts with improvement than among the others.

CONCLUSIONS

Especially previous dropouts with T2D who had poor glycaemic control, may benefit from more frequent contacts including visits and telephone calls. Recalling dropouts does not seem to lead to overuse of the T2D care-system by those recalled patients whose glycaemic control does not require special care.

Impact of intervention on metabolic outcomes among dropouts with type 2 diabetes

PURPOSE

The aim of this study was to evaluate the effect of an individual intervention given by health care professionals to dropouts with type 2 diabetes (T2D) on their metabolic profile.

MATERIALS/METHODS

In 2010, we identified 356 T2D dropouts in Vantaa Health Centre, Finland. At the baseline visit the participants' status was assessed including laboratory tests. Diabetes counseling was given, and drug treatment was enhanced when needed. The follow-up visit was performed 13 to 30 months later including the same assessments as performed at the baseline visit. The dropouts who attended the follow-up visit formed the study group. One third (n=115) of the dropouts participated in the follow-up visit.

RESULTS

The study participants (mean age 61.4 years) were older than the non-participants (mean age 58.5 years) (p=0.009). After the intervention the proportion of participants with hemoglobin A1c≥9% (75mmol/mol) decreased from 15.5% to 5.2% (p=0.004). Improvements were also observed in general in hemoglobin A1c, from 6.6% (49mmol/mol) to 6.3% (45mmol/mol) (p=0.001), in total cholesterol, from 4.9mmol/l to 4.5mmol/l (p=0.011), in low-density lipoprotein cholesterol, from 2.9mmol/l to 2.6mmol/l (p=0.015) and in diastolic blood pressure, from 90mmHg to 84mmHg (p=0.001).

CONCLUSIONS

Dropouts with T2D were difficult to bring back to the public health care system, especially men under the age of 60 years. Dropouts who participated in the intervention showed improvements in several metabolic outcomes.