Abstract
BackgroundPoor understanding of diabetes management targets is associated with worse disease outcomes. Patients may use different information than providers to assess their diabetes control. In this study, we identify the information patients use to gauge their current level of diabetes control and explore patient-perceived barriers to understanding the hemoglobin A1c value (HbA1c).MethodsAdults who self-reported a diagnosis of diabetes were recruited from outpatient, academically-affiliated, Internal Medicine clinics. Semi-structured interviews were conducted with participants and collected data were analyzed using thematic analysis.ResultsThe mean age of the 25 participants was 56.8 years. HbA1c was one of several types of information participants used to assess diabetes control. Other information included perceived self-efficacy and adherence to self-care, the type and amount of medications taken, the presence or absence of symptoms attributed to diabetes, and feedback from self-monitoring of blood glucose. Most participants reported familiarity with the HbA1c (22 of 25), though understanding of the value’s meaning varied significantly. Inadequate diabetes education and challenges with patient-provider communication were cited as common barriers to understanding the HbA1c.ConclusionsIn addition to the HbA1c, several categories of information influenced participants’ assessments of their diabetes control. Increased provider awareness of the factors that influence patients’ perceptions of diabetes control can inform effective, patient-centered approaches for communicating vital diabetes-related information, facilitating behavior change towards improved patient outcomes.
Highlights
Poor understanding of diabetes management targets is associated with worse disease outcomes
Factors influencing participants’ assessments of diabetes control Participants’ assessments of current control fell into the following thematic domains: 1) perceived self-efficacy and adherence to self-management; 2) the types and amount of medications taken; 3) the presence or absence of symptoms attributed to diabetes; 4) numerical data, both the hemoglobin A1c value (HbA1c) and self-monitoring of blood glucose (SMBG); and 5) connections between these domains
While the HbA1c was an important contributor to participants’ evaluations of their diabetes control, participants considered other information, including perceived self-efficacy and adherence to self-care activities, the types and amounts of medications used, the presence or absence of symptoms attributed to diabetes, and Selfmonitoring of blood glucoses (SMBG)
Summary
Poor understanding of diabetes management targets is associated with worse disease outcomes. We identify the information patients use to gauge their current level of diabetes control and explore patient-perceived barriers to understanding the hemoglobin A1c value (HbA1c). Correct knowledge of diabetes management targets is associated with better glycemic control and improved diabetes self-care [1,2,3,4]. Past studies estimate that as few as 25% of people with diabetes can accurately describe the meaning of the hemoglobin A1c value (HbA1c) or recall their most recent value [2, 5] While this may not seem surprising given the conceptual complexity of the HbA1c value (e.g., expressed as a percentage, non-intuitive goal range), even simpler assessments of diabetes control appear difficult [6,7,8]. Better knowledge of the factors influencing patients’ evaluations of their diabetes may enable providers to communicate more effectively regarding diabetes management targets and current levels of diabetes control
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