How patients with insulin-treated type 1 and type 2 diabetes view their own and their physician's treatment goals.

Abstract

To investigate the subjective treatment goals of insulin-treated diabetic patients. 297 type 1 and 205 type 2 diabetic patients, representative of the North-western Swiss population, filled out a self report questionnaire focusing on their own treatment goals using standardized measures wherever available. Factor analysis of the 16 items reflecting their treatment goals revealed four subscales (Crohnbach's alpha): High actual quality of life (0.73), weight reduction/maintenance and daily hassles (0.68), good medical care and knowledge (0.64) and good long term glucose control (0.71). Good long term glucose control was the single most important main treatment goal for most patients (type 1: 60.2%, type 2: 49.7%, p = 0.025). However, both type 1 and type 2 diabetic patients believed that this goal - especially the value of HbA1c - was overestimated (both p <0.0001), while high actual quality of life was underestimated (p = 0.003 and p = 0.05, respectively) by their physicians compared to their own assessment. Good long term glucose control (OR 1.63, p = 0.003) and high actual quality of life (OR 2.17, p <0.0001) were more important and weight reduction/maintenance and coping with daily hassles (OR 0.75, p = 0.07) were slightly less important treatment goals for type 1 than for type 2 diabetic patients. These differences in goals were best associated with the mode of insulin therapy, self-monitoring, and with the extent of diabetes education. Patients believe that physicians overestimate the importance of long term glucose control and underestimate the importance of actual quality of life. Diabetes education and self management have the largest impact on patients' own treatment goals.