Goal Mismatch: Doctors Underestimate Patient Willingness to Get to Target A1c Quickly

By Lucy Chu and Payal Marathe

People with type 2 diabetes are far more willing than their doctors perceive to take action to achieve A1c goals

The American Association of Clinical Endocrinologists (AACE) recently conducted an online survey called “Perspectives in Diabetes Care.” The upsetting, but not altogether surprising result was that people with type 2 diabetes claim they are willing to take action to achieve their A1c goals faster than their doctors perceive.

Of the 1,000 adults with type 2 diabetes surveyed, 55% said they were willing to do more to accelerate progress toward their A1c goal, including more frequent doctor visits and changing medications. Meanwhile, of 1,004 endocrinologists, primary care physicians, and other medical professionals surveyed, only 18% thought people with type 2 diabetes would be willing to make such efforts. That’s an alarming three-fold discrepancy!

Breaking down the data further, 57% of adults with type 2 said they would visit their doctor more often; only 19% of medical professionals believed this to be the case. And while 52% of people with type 2 diabetes said they’d be willing to make multiple medication changes, only 16% of medical professionals perceived this willingness.

This AACE survey, sponsored by Sanofi, provides evidence to back up patient frustrations, which often escalate as people progress through treatment for chronic conditions. On the face of these results, there appears to be a disconnect in communication.

The healthcare system as it stands is based on short, infrequent appointments and doesn’t allow for in-depth, ongoing conversations. Assuming there won’t be a major change in the near future, there are still ways to enhance communication. The following six questions (from the diaTribe guide to individualizing therapy) may be a useful starting point:

• What was your last A1c? How does it compare to the goal you and your healthcare provider are targeting? How has your A1c changed over the last year?

• If you are not at your A1c target, what actions could you take to improve it? Would you benefit by more closely analyzing your blood glucose readings to identify patterns? Do you focus on A1c, daily glucose patterns and glycemic variability, or both?

• Do you frequently experience hypoglycemia? If so, why do you believe these episodes are occurring? What tools or techniques have you considered to reduce this risk, and to monitor it? Does your hypoglycemia limit your daily activities, sense of control, or independence?

• How does your current weight compare to your goal? Has your weight changed recently or over the past year?

• Do you have insurance? How much are you willing to pay out-of-pocket for diabetes therapy?

• What are some of the things that are making it tough to manage your diabetes? Do stress, lack of motivation, or feelings of burnout play a role in your experience with diabetes? If yes, how often?

[Photo Credit: AACE]