Important Outcomes for Type 2 Diabetes Mellitus: The Patient’s Perspective

Context: Patient Important Outcomes (PIOs) was first introduced in the literature with the criticism that research studies were designed with outcomes relevant to health care providers, but not relevant/important to patients. Although physicians identify treatment outcomes for patients with type 2 diabetes mellitus, patients’ perspective on outcomes important to them also need consideration in patient-centered diabetes care.

Objective: To identify important outcomes for type 2 diabetes mellitus care from the perspective of both patients and physicians.

Study Design & Analysis: Mixed methods study employing physician survey and patient focus groups. Quantitative descriptive statistics (frequencies) were calculated for physician survey data. Qualitative thematic analysis using constant comparative technique was used for patient focus group data.

Setting: Academic family medicine clinic in Edmonton, Canada.

Population Studied: Seven physicians and 15 patients took part in the study. English-speaking patients, ≥ 18 years of age with a diagnosis of type 2 diabetes mellitus at least 6 months prior to the study were eligible to participate. Family physicians who practiced at the clinic were eligible to take part.

Intervention/Instrument & Outcome Measures: Family physicians were asked to independently rank a list of common diabetes treatment outcomes. Focus groups were conducted with patients using semi-structured questions. Focus group questions addressed patients’ goals/outcomes regarding successful maintenance of diabetes, healthy living with diabetes, and important future outcomes.

Results: While, there was overlap between patients and physicians in a number of important outcomes, physicians ranked prevention of micro- and macro-vascular outcomes highest, whereas patients focused more on outcomes related to maintenance of their functional abilities/independence. Moreover, patients commented on the value of having their doctor understand what is important to them. Patients also emphasized the importance of multifaceted, individualized care plans, along with a strong doctor-patient relationship, in managing diabetes and preventing adverse physiological and social outcomes.

Conclusion: Differences exist between patient and physicians in important outcomes in diabetes care. It is imperative to the understand the patient’s perspective and to include the patient voice in the delivery of patient-centered diabetes care.