Comparing diabetes mellitus risk perception among patients followed in primary and specialized healthcare: A cross-sectional study in Vaud, Switzerland

Abstract

Purpose: The purpose of this study is to 1) evaluate perceived risk for diabetes among type 2 diabetes patients with different types of diabetes follow-up: diabetologist, general practitioner, or both (“combined follow-up”) in the community and university settings and 2) determine the prognostic factors for better/ higher risk perception of diabetes among these patients. Methods: In this cross-sectional study, we quantified diabetes risk perception using Walker’s RPS-DM survey. The PRIME-MD PHQ questionnaire was used to screen for mood and anxiety disorders. The global risk perception scores were coded in two categories (low/high) and compared across the various types of medical follow-up; univariate and multivariate logistic regression techniques were used to examine the association between perceived risk, patients’ sociodemographic factors, diabetes characteristics and psychological profile. Results: Univariate analysis in logistic regression showed that having combined diabetes follow-up in the university setting was significantly associated with higher composite risk perception (OR=14; 95% CI 3.56-55.05) compared to patients with either single provider type follow-up. Specifically, combined follow- up, was linked to diabetes worry (OR=6.45; 95% CI 1.68-24.7), but also higher perceived risk for diabetes complications (OR=3.55; 95% CI 1.12-11.2). These analyses also showed that perceived risk for diabetes complications was associated with longer diabetes duration (OR=1.05; 95% CI 1.01-1.09), higher number of drug therapies (OR=1.35; 95% CI 1.08-1.69), increased microvascular complications (OR=1.47; 95% CI 1.03- 2.10) and increased vascular complications (OR=1.31; 95% CI 1.02-1.71). Conclusions: Having combined follow-up in the same medical institution increases a patient’s perceived risk of the complications of his/her diabetic illness. Having a more accurate self-perception of potential diabetic complications may help patients make healthier and informed lifestyle choices. Future studies should further examine the association between combined provider follow-up and risk perception, and focus on how patient-provider relationships and follow-up impact diabetic patient outcomes.