Patient Satisfaction and it's Relation to Diabetic Control in a Primary Care Setting

Factors influencing diabetes treatment satisfaction in the INtegrating DEPrEssioN and Diabetes treatmENT randomized clinical trial: A multilevel model analysis

AIMS

Patient satisfaction is associated with positive diabetes outcomes. However, there are no identified studies that evaluate both patient- and clinic-level predictors influencing diabetes care satisfaction longitudinally.

METHODS

Data from the INtegrating DEPrEssioN and Diabetes treatmENT trial was used to perform the analysis. We used fixed and random effects models to assess whether and how changes in patient-level predictors (treatment assignment, depression symptom severity, systolic blood pressure, body mass index, LDL cholesterol, and haemoglobin A1C) from 0 to 24 months and clinic-level predictors (visit frequency, visit cost, number of specialists, wait time, time spent with healthcare provider, and receiving verbal reminders) measured at 24 months influence diabetes care satisfaction from 0 to 24 months.

RESULTS

Model 1 (patient-level predictors) accounted for 7% of the change in diabetes satisfaction and there was a significant negative relationship between change in depressive symptoms and care satisfaction (β = -0.23, SE = 0.12, p < 0.05). Within Model 1, 2% of the variance was explained by clinic-level predictors. Model 2 included both patient- and clinic-level predictors and accounted for 18% of the change in diabetes care satisfaction. Within Model 2, 9% of the variance was attributed to clinic-level predictors. There was also a cross-level interaction where the change in depression had less of an impact on the change in satisfaction for those who received a verbal reminder (β = -0.11, SE = 0.21, p = 0.34) compared with those who did not receive a reminder (β = -0.62, SE = 0.08, p < 0.01).

CONCLUSIONS

Increased burden of depressive symptoms influences diabetes care satisfaction. Clinic-level predictors also significantly influence diabetes care satisfaction and can reduce dissatisfaction in primary care, specifically, reminder calls from clinic staff.

Patient satisfaction of primary care services in Gulf Cooperation Council Countries: A scoping review

Patient satisfaction (PS) is an essential element in evaluating and improving healthcare systems. Few studies have gathered evidence about patient satisfaction with primary care (PC) services in the Gulf Cooperation Council (GCC) countries. Therefore, it is important to review the existing literature examining PS with PC services in the GCC countries. This scoping review was conducted for primary data studies published between 2000 to March 2022. Out of 4461 screened articles, 37 met the inclusion criteria. Most studies were conducted in Saudi Arabia and were of cross sectional methodology. PS with primary care in the GCC is affected by multiple provider-related and patient-related factors and users are generally satisfied with the service provided. Future research should focus on the effects of the factors that were not explored and validate the existing results.

A Survey on Factors Affecting Knowledge and Satisfaction with Care Among Persons with Diabetes Mellitus in an Urban Health Centre and its Outreach Clinics in South India

Objective

To determine the level of knowledge and factors affecting knowledge and satisfaction with diabetes care among persons with diabetes at urban health centre (UHC) and community health worker (CHW)-led outreach clinics (ORC) in South India.

Methodology

A cross-sectional study was carried out using a structured questionnaire. One hundred patients at the UHC and 200 patients at the ORC were included.

Results

Patients with DM of more than eight years, with co-morbidities and maintained on insulin had good knowledge at the UHC. At the ORC, participants who received education beyond the primary level and belonging to non - Hindu religion had higher knowledge. Patients at the ORC experienced better satisfaction in terms of waiting time for appointments, consultation, registration system and counselling. At the UHC, those who received primary education or those with lower educational attainment had better satisfaction. Overall, knowledge (p = 0.03) and satisfaction (p = 0.00001) of diabetes care was better at the ORC than at the UHC.

Conclusions

Our study found better knowledge and satisfaction with diabetes care at the ORC than at the UHC. Whether or not the difference can be attributed to CHW-based clinics in the community needs to be further elucidated.

Patients' Satisfaction, Diabetic Control and Associated Factors at a Tertiary Health Facility in Rivers State, Nigeria

Background

Non-communicable diseases (NCDs) are the leading cause of death globally and diabetes mellitus (DM) is the fourth main contributor. The incidence of its complications could be reduced with high-quality care and good glycaemic control. Treatment satisfaction is an important aspect of quality of care, especially in treating chronic diseases like DM. This study sought to determine the satisfaction of diabetics with their care and to identify the relationship between patients' satisfaction and diabetic control alongside other associated factors.

Methodology

The study was a descriptive cross-sectional, hospital-based study. Respondents were admitted into the study based on inclusion criteria and selected using a systematic random sampling technique. Blood samples for fasting plasma glucose and total cholesterol were collected. Diabetic Treatment Satisfaction Questionnaire and the Patient Satisfaction Questionnaire were used to assess treatment satisfaction. The SPSS version 21.0 was used for data analysis and linear regression was used to determine the factors influencing satisfaction. The level of significance was set at 0.05.

Results

The mean total Diabetes Treatment Satisfaction score was 33.8 ± 8.2 and the mean total Short-Form Patient Satisfaction score was found to be 16.8 ± 3.6. There was a statistically significant difference between the mean satisfaction scores with treatment of diabetes mellitus and age groups (p < 0.001). There was also a statistically significant association between DM treatment satisfaction with the use of oral antidiabetic agents (p = 0.043) and the presence of complications (P < 0.001).

Conclusion

There was a significant correlation between patient satisfaction scores and other factors like accessibility and convenience, time spent with doctors, and so on. In conclusion, the study identified the use of oral anti-diabetic agents, and the presence of complications, among others as factors affecting patient satisfaction. This study, therefore, suggests improving the practice of patient-centered medicine by increasing patient satisfaction through addressing these factors.

Dissatisfaction of people with type 2 diabetes with the care received at a diabetes clinic in Ningbo, China: A cross-sectional study

Aim

The study aimed to assess the dissatisfaction of people with type 2 diabetes mellitus (T2DM) with the care that they received at a diabetes outpatient clinic in Ningbo, China and to determine the associated factors.

Methods

A cross‐sectional study was conducted among 406 adults with T2DM in 2020–2021. Those who were treated at the diabetes outpatient clinic for at least six consecutive months before the survey date were eligible. The Short Assessment of Patient Satisfaction scale was used to assess participants' dissatisfaction with the care that they received.

Results

Of the participants, 25.1% were not satisfied with the care that they received at the diabetes outpatient clinic in Ningbo. The odds of dissatisfaction were higher in physically active people compared to those who were not (odds ratio [OR]: 3.41; 95% confidence interval [CI]: 1.56–7.45) and those with >1–5 years of T2DM compared to ≤1 year (OR: 2.18; 95% CI: 1.05–4.53).

Conclusion

A quarter of people with T2DM were dissatisfied with the care that they received at the diabetes outpatient clinic in Ningbo, China, and the factors associated with dissatisfaction were identified.

Evaluation of Patient Satisfaction and Clinical Efficacy of Using Blood Glucose Meters Featuring Color-Coded Indicators in Patients With Type 1 Diabetes: An Observational Hospital-Based Study

Introduction Because of the difficulties in interpreting the level of blood glucose using the traditional numeric glucometers, the blood glucose meters featuring color-coded range indicators (CRI) offered a simple way to understand and interpret blood glucose readings. Therefore, this study aimed to assess glucose monitoring satisfaction (GMS) and clinical efficacy of blood glucose meters featuring color-coded in patients with Type 1 Diabetes (T1DM) in Saudi Arabia. Methods T1DM patients who switched to color-coded Medisafe Fit Smile glucometer were included in this study. Demographic data, clinical characteristics, glycemic parameters were collected. A trained interviewer collected the GMS survey at baseline and 12 weeks. At the end of the study, patient-reported satisfaction with the Medisafe Fit Smile color-coded features (MSCF) survey was collected.  Results This study included 62 T1DM patients with a mean age of 17.8 (±3.1), and the majority had three or more confirmed hypoglycemic episodes per month. Compared to baseline data, we showed a significant improvement in the mean hemoglobin A1C level (8.43 [±1.2] versus 8.36 [±1.1], p<0.001), with a significantly lower frequency of hypoglycemic episodes (2.74 [±1.1] versus 2.0 [±0.78], p<0.001) after 12 weeks of using glucometer featuring CRI. Most importantly, significant improvements in the GMS survey subdomains of openness (p<0.001), emotional burden (p<0.001), behavioral burden (p<0.001), but not trust (p=0.71) were detected at the end of the study with a significantly higher total GMS survey of 4.33 (±0.13) after using blood glucose meters featuring CRI compared to the lower score of 2.84 (±0.22) at baseline (p<0.001). Furthermore, patient satisfaction with the MSCF survey revealed evidence of satisfaction among the TIDM patients at the end of the study. Conclusion The current study confirmed that individuals with T1DM may benefit from blood glucose meters featuring CRI device exposure. Also, using a glucometer featuring CRI was associated with a high level of satisfaction with blood glucose measures and significant improvement in the glycemic parameters. However, definitely, further studies are needed to confirm whether the long-term use of the CRI-based blood glucose meters will produce improved results in the GMS survey.

Evaluation of Patient-Reported Satisfaction and Clinical Efficacy of Once-Weekly Semaglutide in Patients with Type 2 Diabetes: An Ambispective Study

INTRODUCTION

The method of therapy administration and injection device characteristics have been documented to influence perceptions and preference of treatment among patients with type 2 diabetes (T2D). We aimed to assess the metabolic effectiveness and patient-reported satisfaction of once-weekly semaglutide compared to liraglutide in suboptimally controlled patients with T2D.

METHODS

We conducted this single-center cohort study at diabetes center clinics at a tertiary care hospital between February 2021 and August 2021. We included suboptimally controlled patients with T2D who had been treated with liraglutide for at least 3 months at baseline, then shifted to once-weekly semaglutide and followed up for the same period. Ambulatory glucose profile (AGP) metrics [i.e., mean glucose level, glycemic variability (GV), time above range (TAR), and time in range (TIR)] for baseline and follow-up were compared. To assess the satisfaction with shifting, we used the valid Arabic version of the Diabetes Treatment Satisfaction Questionnaire status (DTSQs) and change (DTSQc) while the injection device preference was assessed using the Diabetes Injection Device Preference Questionnaire (DID-PQ).

RESULTS

We included 52 patients (25 male and 27 female), with a mean age of 48 (± 6) years and a mean diabetes mellitus duration of 7.27 (± 3.79) years. We observed a significantly decreased mean HbA1c level following semaglutide treatment (7.79% at study end vs. 8.07% at baseline, p < 0.001) and body weight (84.64 ± 7.68 vs. 87.15 ± 8.011, p < 0.001). Compared to the glucometrics data at baseline, we observed a significantly improved mean average glucose, GV, TAR, and TIR (p < 0.001). Data from the DTSQs and DTSQc questionnaires showed a high level of patient-reported satisfaction after shifting to semaglutide treatment. All patients preferred/strongly preferred once-weekly semaglutide over liraglutide in most DID-PQ questionnaire domains.

CONCLUSIONS

Switching from once-daily liraglutide to once-weekly semaglutide led to improvements in both clinical measures of glycemic control and patient-reported satisfaction.

Structural Factors and Quality of Diabetes Health Services in Hail, Saudi Arabia: A Cross-Sectional Study

The chronic disease burden in Saudi Arabia has created adverse health, social and economic consequences that require urgent attention from health and political authorities. Diabetes has become an epidemic in Saudi Arabia. Data on personal and structural factors associated with diabetes in the Hail region are scarce. Such data are imperative to develop effective strategies to control the epidemic in the region. A cross-sectional study of diabetes patients attending diabetes health care facilities in Hail was conducted using a sample of 392 patients. An interviewer-administered questionnaire was used. A slightly higher proportion of female participants (54.1%) were included in the sample. Most of the participants were from rural areas (73.9%), and 70.9% of the participants were from the middle-age (30–50 years) category. A close proximity to the diabetes clinic (OR = 1.98; 95% CI: 1.08–3.44), good transport facilities (OR = 1.67; 95% CI: 1.11–2.78) and feeling contented with supportive services (OR = 2.03; 95% CI: 1.12–4.04) were associated with patients’ satisfaction with the overall quality of the diabetes clinic services. The presence of good-quality health care professionals working in these treatment centers also seemed to contribute to patients’ satisfaction with the services they received. These structural factors associated with patients’ satisfaction with the services they received from diabetes clinics must be considered in diabetes control programs in the region. The minimization of structural barriers will eventually assist the national strategic plan, Vision 2030, which aims to improve the quality of life of the Saudi people by 2030.

Assessment of Patient, Physician, Caregiver, and Healthcare Provider-Related Factors Influencing "Glycemic Happiness" of Persons with Type 2 Diabetes Mellitus: An Observational Survey

A multicentric cross-sectional observational survey was conducted to understand the patient, physician, nurse, caregiver, and diabetes counselor/educator-related factors that define the “glycemic happiness” of persons with type 2 diabetes mellitus (T2DM). Five sets of questionnaires based on a five-point Likert scale were used. A total of 167 persons with T2DM, 167 caregivers, and 34 each of physicians, nurses, and diabetes counselors/educators participated. For persons with T2DM, an adequate understanding of diabetes (mean score ± standard deviation: 4.2 ± 0.9), happiness and satisfaction with life (4.1 ± 0.8), flexibility (4.2 ± 0.8) and convenience (4.2 ± 0.7) of treatment, and confidence to handle hypo/hyperglycemic episodes (4.0 ± 0.9) were the factors positively associated with glycemic happiness. Caregivers’ factors included information from physicians on patient care (4.5 ± 0.6), constructive conversations with persons with T2DM (4.2 ± 0.8), helping them with regular glucose monitoring (4.2 ± 0.9), and caregivers’ life satisfaction (4.2 ± 0.8). Factors for physicians, nurses, and diabetes counselors/educators were belief in their ability to make a difference in the life of persons with T2DM (4.8 ± 0.4, 4.4 ± 0.5, and 4.5 ± 0.5), satisfaction from being able to help them (4.9 ± 0.3, 4.6 ± 0.5, and 4.6 ± 0.5), and professional satisfaction (4.9 ± 0.4, 4.4 ± 0.6, and 4.7 ± 0.4). Our survey identified the key factors pertaining to different stakeholders in diabetes care, which cumulatively define the glycemic happiness of persons with T2DM.

Practical Considerations for Initiating and Utilizing Flash Continuous Glucose Monitoring in Clinical Practice

Use of continuous glucose monitoring (CGM) has been shown to improve clinical outcomes in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), including improved glycemic control, better treatment adherence, and an increased understanding of their treatment regimens. Retrospective analysis of CGM data allows clinicians and patients to identify glycemic patterns that support and facilitate informed therapy adjustments. There are currently 2 types of CGM systems: real-time CGM (rtCGM) and flash CGM. The FreeStyle Libre 2 (FSL2) is the newest flash CGM system commercially available. Because the FSL2 system was only recently cleared for use in the US, many endocrinologists and diabetes specialists may be unfamiliar with the strengths, limitations, and potential of the FSL2 system. This article focuses on practical approaches and strategies for initiating and using flash CGM in endocrinology and diabetes specialty practices.

Confirmatory Factor Analysis and Reliability of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for Arabic Speaking Patients with Type II Diabetes

Background

Treatment satisfaction is an important indicator for treatment compliance and glycemic control. Although psychometric properties of the Diabetes Treatment Satisfaction Questionnaire have been confirmed in several languages, it remains unclear the extent to which the factorial structure of this tool is valid for Arabic speaking populations.

Purpose

This study set out to confirm the construct validity of the Arabic version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) by investigating the fit of published factor structures and the reliability of responses in patients diagnosed with type 2 diabetes.

Methods

Data were from a large cross-sectional study of 1002 patients with diabetes in Jordan. Confirmatory factor analysis was used to compare three different models of the 8-item questionnaire (one factor, two factors, three factors) across patients treated with insulin and patients treated with oral hypoglycaemic medications.

Results

Statistics covered the factorial validity and omega reliability coefficient (Ω_w) of the DTSQ. We were able to replicate the three different models of the 8-item Diabetes Treatment Satisfaction Questionnaire reported in previous studies, yet a two-factor model provided the best fit to the data in our sample with omega reliability coefficient (Ω_w) of the subscales above 0.70.

Conclusion

The finding suggests a cross-cultural invariance of the factor structure of the Arabic version of the Diabetes Treatment Satisfaction Questionnaire, as we were able to replicate the same factor structure using the Arabic translated version of the tool and using non-English speaking participants. Within known limitations and gaps in the literature, healthcare professionals working with Arabic speaking patients may find this tool useful for identification of high-risk patients and those in need for interventions to promote glycemic control.

Practical guidance for using the FreeStyle Libre flash continuous glucose monitoring in primary care

Use of continuous glucose monitoring (CGM) improves clinical outcomes in type 1 diabetes, and significant benefits been demonstrated in patients with type 2 diabetes, including improved glycemic control, better treatment adherence, and an increased understanding of their treatment regimens. Currently, there are two types of CGM systems: real-time CGM (rtCGM) and flash CGM (FCGM). Retrospective analysis of CGM data allows patients and their clinicians to identify glycemic patterns that support and facilitate informed therapy decisions. With the increasing prevalence of diabetes, primary care physicians will be compelled to take on more responsibility for managing patients with diabetes. This article focuses on practical approaches and decision-making strategies for utilizing FCGM in primary care settings.

Socioeconomic status moderates the association between patient satisfaction with community health service and self-management behaviors in patients with type 2 diabetes: A cross-sectional survey in China

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM).In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors.The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55), increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR 1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR 1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants ≥65 years old, who also had lower SES and higher-status occupations, was also observed.The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.

Services satisfaction of type 2 diabetic patients attending Arar's diabetic center, Saudi Arabia

OBJECTIVES

To determine type 2 diabetic patients' satisfaction with the services provided by the Diabetic Center, Arar, Saudi Arabia, and to assess the relationship between patients' satisfaction and their diabetic control. Methods: An observational cross-sectional study, carried out in 322 patients at the Arar Diabetic Center, Arar, Kingdom of Saudi Arabia between January and April 2018. A systematic random sampling technique was applied to include every second type 2 diabetic patient attending the center. We interviewed the type 2 diabetic patients using a predesigned questionnaire tested for validity and reliability. Results: The mean age of the studied population was 48.5±13.05. The overall satisfaction rate was 65.8%. There was a significant association between patient satisfaction to both self-reported health status (p=0.001) and mode of treatment (p=0.02). Regarding service related factors: 78% of patients were satisfied with the time spent during consultation; 58.7% were satisfied with information given regarding the disease; 58.7% were dissatisfied with dietary advice; and 44.7% were dissatisfied with information given regarding medications. Hemoglobin A1c (HbA1c) was controlled in 64% of patients. There was a statistically significant association between patients' dissatisfaction and poor diabetic control. Conclusion: Two-thirds of the patients were satisfied with the services provided by the Diabetic Centres of Arar city, Saudi Arabia. The study recommends emphasis on patient education and addressing patient needs and worries.

Integrated personalized diabetes management improves glycemic control in patients with insulin-treated type 2 diabetes: Results of the PDM-ProValue study program

AIMS

Globally, many patients with insulin-treated type-2 diabetes are suboptimally controlled. The PDM-ProValue study program evaluated whether integrated personalized diabetes management (iPDM) has the potential to improve clinical outcomes.

METHODS

101 practices with 907 patients participated in the 12-month, prospective, controlled, cluster-randomized study program. HbA1c levels, therapy changes, frequency of hypoglycemic episodes, patient reported outcomes, and physician satisfaction were assessed.

RESULTS

iPDM led to a greater reduction in HbA1c after 12 months vs. usual care (-0.5%, p < 0.0001 vs. -0.3%, p < 0.0001), (Diff. 0.2%, p = 0.0324). Most of the HbA1c reduction occurred after 3 months and remained stable thereafter. The percentage of patients with therapy adjustments was higher in the iPDM group at all visits (p < 0.01 at week 3, month 3, month 6). Patient adherence at month 12 was higher in the iPDM group compared to baseline (Odds ratio = 2.39; p = 0.0003); also, patient treatment satisfaction (DTSQc: 12.2 vs. 10.4, δ = 1.78, p = 0.004; DTSQs: 31.0 vs. 30.0, δ = 0.924, p = 0.02), and physician satisfaction was higher in the intervention group.

CONCLUSIONS

iPDM improved the use of diagnostic data leading to better glycemic control, more timely treatment adjustments (indicating reduced clinical inertia), and increased patient adherence and treatment satisfaction among patients and physicians.

The effect of continuity of care on the incidence of end-stage renal disease in patients with newly detected type 2 diabetic nephropathy: a retrospective cohort study

Background

Diabetic nephropathy requires periodic monitoring, dietary modification, and early intervention to prevent the disease severity within limited resource settings. To emphasize the importance of continuous care for chronic diseases, various studies have focused on the association between continuity of care (COC) and common adverse outcomes. However, studies aimed at understanding the effect of COC on the incidence of chronic diseases, such as end-stage renal disease (ESRD), are few. The aim of this study was to determine whether there is an association between COC and the incidence of ESRD among patients with diabetic nephropathy. Moreover, we identified individual- and hospital-level factors associated with the incidence of ESRD among diabetic nephropathy patients.

Methods

We conducted a retrospective cohort study using the administrative National Health Insurance claims data from 2005 to 2012 in the Republic of Korea. The dependent variable, a binary variable, was the incidence of ESRD due to diabetic renal complication. In addition, using the COC index as a binary variable with a cutoff point of 0.75, we divided patients into a ‘Good COC group’ (COC index≥0.75) and a ‘Bad COC group’ (COC index< 0.75). The survival analysis was performed using the Cox proportional hazards models.

Results

Among 3565 diabetic renal complication patients, ESRD occurred among 83 diabetes mellitus patients (2.3%). Nephropathy patients with lower COC level (< 0.75) had 1.99 times higher risk of ESRD incidence (95% confidence interval [CI]:1.27–3.12). In addition, the lowest income level patients had higher hazard ratio (HR) of ESRD than the highest income level patients (HR: 1.69 95% CI: 0.95–2.98), while patients with disabilities had 2.70 higher HR of ESRD than patients without disabilities (95% CI: 0.64–43).

Conclusions

Among patients with diabetic renal complication, higher continuity of care was associated with lower risk of ESRD. It is therefore recommended that continuous follow-up be encouraged to prevent ESRD among diabetic renal complication patients. Moreover, disparities in health outcomes between socially vulnerable groups including patients with disabilities and those in the lowest income level should be addressed.

Electronic supplementary material

The online version of this article (10.1186/s12882-018-0932-3) contains supplementary material, which is available to authorized users.

Use of a Novel, Remotely Connected Diabetes Management System Is Associated with Increased Treatment Satisfaction, Reduced Diabetes Distress, and Improved Glycemic Control in Individuals with Insulin-Treated Diabetes: First Results from the Personal Diabetes Management Study

BACKGROUND

The ability to automatically transfer data to clinicians and receive timely guidance in therapy adjustments through remote and in-office consults can positively impact patients' perceptions about quality of care, which is positively associated with clinical outcomes. We assessed the impact of using the Accu-Chek Connect diabetes management system on treatment satisfaction, diabetes distress, and glycemic control in adults with type 1 diabetes and insulin-treated type 2 diabetes.

SUBJECTS AND METHODS

This 6-month, prospective, multicenter, single-arm study assessed the impact of using the system on treatment satisfaction and glycemic control among 87 adults with insulin-treated diabetes (multiple daily insulin injections and basal only), with 8.8% ± 1.6% glycated hemoglobin (HbA1c) at baseline. The Diabetes Treatment Satisfaction Questionnaire-status (DTSQs) and Diabetes Distress Scale (DDS) were administered at baseline, and the Diabetes Treatment Satisfaction Questionnaire-change (DTSQc) and DDS at 6 months. Changes in HbA1c, average blood glucose (BG), and other metrics were also assessed.

RESULTS

Improvements in DTSQc scores were observed at 6 months with a total mean (standard deviation) score of 14.3 ± 5.1. Significant reductions in total mean DDS scores from baseline to 6 months were also observed, from 2.0 ± 0.8 to 1.7 ± 0.7, P < 0.0001. A significant reduction in regimen-related distress was notable, from "moderate distress" (2.4 ± 1.0) to "not distressed" (1.9 ± 0.9), P < 0.0001). Significant reductions in mean HbA1c (-0.9 ± 1.6, P < 0.0001) and mean BG (-24.8 ± 50.8, P < 0.0001) were observed.

CONCLUSIONS

Use of the Accu-Chek Connect diabetes management system is associated with increased treatment satisfaction and improved glycemic control among individuals with insulin-treated diabetes. NCT02600845 ( www.clinicaltrials.gov ).

Innovative curriculum for second-year Harvard-MIT medical students: practicing communication skills with volunteer patients giving immediate feedback

PURPOSE

Medical students are expected to develop excellent communication skills. The purpose of our study was to create an innovative communication skills exercise using real volunteer patients and physician co-teachers for students to practice communication skills while receiving immediate feedback.

METHOD

This is a mixed methods study where second-year medical students participated in the communication skills exercise with real patients and physician co-teachers giving immediate feedback. Clinical scenarios reflected the patients' actual experiences. Students acted out roles as physicians. Physicians co-taught with the patients and gave immediate feedback to students. Students completed an anonymous written survey at the end of the exercise. Qualitative and quantitative responses were recorded. Student feedback from the 2014 surveys was used to modify the teaching designs to increase active role play opportunities by having only two students in each group and doubling the number of stations with real patients.

RESULTS

Students rated the overall exercise and the utility of patient volunteers in learning how to communicate on a Likert scale of 1-5, where in this medical school traditionally 1 is excellent and 5 is poor. In 2014, the exercises were rated with a mean score of 1.47 (SD 0.621). In 2015, the exercises were rated with a mean score of 1.03 (SD 0.62). In 2016, the exercises were rated with a mean score of 1.27 (SD 0.52). ANOVA analysis (p=0.002) and Bonferroni corrections indicate a statistically significant difference between combined mean scores of the exercise in 2014 and 2015 (p=0.001). No difference was shown between 2014 and 2016 or 2015 and 2016.

CONCLUSIONS

Medical students rated practicing communication skills with real patient volunteers and physician co-teachers giving immediate feedback in their preclinical years very highly. Student feedback indicated that they preferred active roles and increased opportunities to practice their communication skills.

Validation of an Arabic version of the Diabetes Treatment Satisfaction Questionnaire in Qatar

AIMS

Several instruments evaluate patient-reported outcomes in diabetes mellitus (DM), but almost none are validated for use in Arabic language. The aim of this study is to test the psychometric properties and responsiveness of the Arabic version of the Diabetes Treatment Satisfaction Questionnaire (DTSQs) in Qatar.

METHODS

Ambulatory Arabic speaking DM patients were interviewed at two consecutive time points in Doha, Qatar. The 8-item DTSQs was administered in conjunction with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the World Health Organization Quality of Life Measure (WHOQOL-Bref) to assess convergent validity. Reliability was evaluated by internal consistency and item analysis. Construct validity was evaluated using "known groups" comparisons (including gender, insulin use, and HbA1c). Sensitivity of DTSQs scores to the subject's metabolic conditions was determined.

RESULTS

One hundred subjects (mean age 50.7) participated. Half (54%) were female. The majority (93%) had Type 2 DM, but 39 (42%) were using insulin. Results revealed satisfactory internal consistency. Metabolic measures (fasting blood glucose and AIC) had significant inverse correlations with DTSQs scores (interview 1, Pearson's r=-0.333 and r=-0.401, respectively, p<0.01). Scale criterion and construct validity were found to be satisfactory. Most sub-dimensions of the SF-36 and WHOQOL-Bref were correlated with the DTSQ, indicating a good concurrent validity. As in prior studies, women demonstrated poorer treatment satisfaction.

CONCLUSIONS

The Qatar Arabic DTSQs version was found to be a reliable and valid instrument for the assessment of treatment satisfaction in Arabic diabetes mellitus patients in the country.

Patient-reported outcome measures and risk factors in a quality registry: a basis for more patient-centered diabetes care in Sweden

Diabetes is one of the chronic diseases that constitute the greatest disease burden in the world. The Swedish National Diabetes Register is an essential part of the diabetes care system. Currently it mainly records clinical outcomes, but here we describe how it has started to collect patient-reported outcome measures, complementing the standard registry data on clinical outcomes as a basis for evaluating diabetes care. Our aims were to develop a questionnaire to measure patient abilities and judgments of their experience of diabetes care, to describe a Swedish diabetes patient sample in terms of their abilities, judgments, and risk factors, and to characterize groups of patients with a need for improvement. Patient abilities and judgments were estimated using item response theory. Analyzing them together with standard risk factors for diabetes comorbidities showed that the different types of data describe different aspects of a patient's situation. These aspects occasionally overlap, but not in any particularly useful way. They both provide important information to decision makers, and neither is necessarily more relevant than the other. Both should therefore be considered, to achieve a more complete evaluation of diabetes care and to promote person-centered care.