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Treatment perceptions andmisunderstandings with cliniciansin people with diabetes

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Understand in more detail similarities and differences between clinicians’ and patients’ perceptions regarding the treatment for T2DM

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Treatment perceptions andmisunderstandings with cliniciansin people with diabetes

  1. 1. Treatment perceptions and misunderstandings with clinicians in people with diabetes 30-10-2015 1 Peter Schwarz Anne-Marie Felton Michael Cobble Ayeza Bonilla Islas Johan Wens
  2. 2. Aims 30-10-2015 2 understand in more detail similarities and differences between clinicians’ and patients’ perceptions regarding the treatment for T2DM Research questions • How do patients and clinicians perceive the need for treatments that manage challenges beyond hyperglycemia, including obesity, lipids, hypertension, … ? • How perceive clinicians and patients meaningful weight loss? • How perceive clinicians and patients weight management as a motivator to patient self-management? • How to characterize the disconnect between patients and clinicians regarding the above?
  3. 3. Methods 30-10-2015 3 online survey 10 minute structured online questionnaire across 13 countries stepwise design: - originally drafted by HCP focussing on the main objectives - developed by an iterative Delphi type approach - mirrored questions for clinicians and PWD (“people with diabetes”) - reviewed by international T2DM experts - reviewed by clinicians from external steering committee - piloted by some PWDs - tested in small number of PWD from English speaking country
  4. 4. Methods 30-10-2015 4 After pilot testing - data reviewed to ensure good understanding of scripts 2nd pilot of PWD questionnaire - as further check for language, length, flow and clarity Final survey - translated in local languages - back-translated in English to confirm language and face validity
  5. 5. Methods 30-10-2015 5 Data collection - baseline demographics - mix of question types - 4 and 5 point semantic (Likert) scales - frequency counts of 1st, 2nd or 3rd ranks - pre-coded / dichotomous questions Analysis primarily conducted to show percentage distributions of ranks across the samples as applicable at a global/country level
  6. 6. Participants 30-10-2015 6 Clinicians identified in response of answers to questions about the healthcare they provided and the medical conditions they treated People with T2DM (PWD) recruited from - online communities - social media - affiliated partners - web-based sources selected their condition from a list of different conditions without being informed about qualifying condition for the survey
  7. 7. Participants 30-10-2015 7 PWD Clinicians France Germany Italy Spain UK US Canada PWD Clinicians China Japan Brazil Mexico Australia South Africa TOTAL
  8. 8. Participants 30-10-2015 8 PWD Clinicians France Germany Italy Spain UK US Canada PWD Clinicians China Japan Brazil Mexico Australia South Africa TOTAL 2140 1406
  9. 9. Participants 30-10-2015 9 PWD Clinicians France 177 100 Germany 179 103 Italy 175 100 Spain 150 101 UK 175 100 US 331 200 Canada 128 102 PWD Clinicians China 226 100 Japan 150 100 Brazil 100 100 Mexico 101 101 Australia 101 97 South Africa 147 100 TOTAL 2140 1406
  10. 10. Participants 30-10-2015 10 n PWD % obese % overweight France 177 48 27 Germany 179 58 30 Italy 175 29 40 Spain 150 33 44 UK 175 51 24 US 331 61 20 Canada 128 61 16 n PWD % obese % overweight China 226 42 20 Japan 150 49 25 Brazil 100 42 35 Mexico 101 35 40 Australia 101 56 28 South Africa 147 39 38 TOTAL 2140 50 30 using country specific BMI definitions
  11. 11. Type of Healthcare practitioner 30-10-2015 11 PCPs/GPs Nurses Specialists** China 100 - - Japan 100 - - Brazil 50 - 50 Mexico 51 - 50 Australia 70 29 - South Africa 100 - - TOTAL 1035 171 200 PCPs/GPs Nurses Specialists** France 100 - - Germany 71 32 - Italy - - 100 Spain 101 - - UK 70 30 - US 150 50 - Canada 72 30 - **Includes diabetologists/ endrocrinologists (Italy/LatAm); cardiologists (LatAm); specialist Internists (LatAm)
  12. 12. Participants - demographics 30-10-2015 12 13 15 26 31 16 <35 35-44 45-54 55-64 >65 58 42 Male Female Gender Age 50 27 10 11 2 Employed Retired Unable to work Unemployed 5 13 25 19 38 1 2 3 4 5 Second stage of tertiary education First stage of basic education Education level Employment status (Upper) secondary education Lower secondary education Post- secondary (vocational) education
  13. 13. Participants 30-10-2015 13 Time since T2D diagnosis PCP / internist 52% Diabetes specialist 37% Diabetes nurse 4% Primary care nurse 1% Pharmacist 1% Other specialist 4% Country variations: PCP: US = 77%; Canada = 72%; Australia = 67% Diabetes specialist: China = 79%; Italy = 65%; Brazil = 62% Diabetes nurse = UK = 29% Main T2D treater
  14. 14. Participants – co-morbidities 30-10-2015 14 Fr Ger It Sp UK US Can Bra Mex Chn Jpn Aus SA 11 13 9 6 8 11 10 7 11 9 15 12 Co-morbidities High blood pressure High cholesterol Vision problems (due to diabetes) Circulation problems Kidney problems Heart attack Heart surgery angioplasty, stent, CABC, Stroke None of these % with Each Co-morbidity by Country 17 27 21 18 15 19 22 31 7 9 15 24 15 27 17 13 13 16 29 28 27 13 12 29 42 68 66 45 69 76 68 70 38 68 42 65 67 51 63 50 65 66 65 52 46 48 38 63 33 16 11 21 14 9 14 10 21 11 31 13 12 6 4 5 5 5 10 5 2 8 3 2 7 9 5 2 6 12 7 8 1 3 6 17 4 11 13 9 6 8 11 10 7 11 9 15 12
  15. 15. Participants – current treatment 30-10-2015 15 15 4 5 28 9 24 15 Diet and exercise & Oral & injectable medication Injectable medicine & Oral medication Diet and exercise & Injectable medication Diet and exercise & Oral medication Injectable medication only Oral medication only Diet and exercise only Patients receiving injectable = 33% Patients on oral therapy = 72% % Of whom
  16. 16. Participants – current treatment 30-10-2015 16 46 77 73 84 77 38 25 20 63 23 Oral Injectable 72 71 76 71 67 67 70 74 23 28 32 23 29 37 34 24 *Source: Decision Resources “Type 2 Diabetes in China,” May 2008 and AZ Global Diabetes Forecasting with IMS MIDAS data France Germany Italy Spain UK US Canada Brazil Mexico China Japan Australia South Africa
  17. 17. Challenges for clinicians… 30-10-2015 17 2 2 1 1 11 9 9 7 3 56 63 65 59 44 31 26 25 33 52 Indifferent Not at all challenging Challenging Very challenging% Weight Microvascular Complications Glycemic Control Managing CV Risk Patient Compliance 96% 92% 90% 89% 87% Top 2 Boxes Score (Challenging / Very challenging 4 3 2 4 2 33 31 25 21 22 54 52 60 59 61 10 14 13 16 15BP Control Delay progression to insulin Cholesterol Control Minimize episodes of hypos Managing side effects of T2D treatment 76% 75% 73% 66% 64%
  18. 18. Concerns of PWD… 30-10-2015 18 0 10 20 30 40 50 60 70 achieve/maintain target BP achieve/maintain target cholesterol managing side-effects of treatment regularly forgetting to take tablets minimising hypoglycemic episodes suffering from microvasc. complications increased risk of CV complications achieve/maintain glycaemic control achieve/maintain target weight PWD (n = 2140) HCP (n = 1406)
  19. 19. Concerns of PWD and HCP 30-10-2015 19 0 10 20 30 40 50 60 70 achieve/maintain target BP achieve/maintain target cholesterol managing side-effects of treatment regularly forgetting to take tablets minimising hypoglycemic episodes suffering from microvasc. complications increased risk of CV complications achieve/maintain glycaemic control achieve/maintain target weight PWD (n = 2140) HCP (n = 1406)
  20. 20. Differences in feelings on … 30-10-2015 20 16% 15% 7% 6% 2% -5% -5% -8% -12% -20% -21% -30% -20% -10% 0% 10% 20% 30% Forget to take tablets Cholesterol control Forget to inject* BP control Side effects Manage weight Diabetes complications* CV event (e.g., MI/stroke) Manage blood sugar Having to inject in future*** Having to inject self now* Percentage of PwD minus Clinicians Saying Consideration “Makes Patients Moderately / severely Anxious” (Top 2 Box) +/-10% was judged to be threshold of clinically meaningful differences between patients and clinicians Patients less concerned in relation to what Clinicians perceive Patients similarly concerned in relation to what Clinicians perceive Patients more concerned in relation to what Clinicians perceive * Such as retinopathy kidney failure, neuropathic symptoms, diabetic foot. •**Asked only to patients currently injecting •***Asked only to patients currently not injecting All differences between Clinicians & patients are statistically significant at 95% CI
  21. 21. Differences in which feels the worst… 30-10-2015 21 0 10 20 30 40 50 60 70 Risk of Diabetic Complications Side Effects of Treatment Hypoglycemia Managing Weight Managing Blood Sugar Risk of Heart Attack / Stroke Managing Blood Presure Maintaining Cholesterol Levels Forgetting to Take Tablets % of Respondents Indicating “Top 3 Box” Level of Concern Situation/Challenge Differences in Level of Patients Concern vs. What Clinicians Perceive Patients Clinicians *Statistically comparable or statistically different (95% CI) Patients equally concerned as clinicians* Patients more concerned than clinicians* Patients less concerned than clinicians*
  22. 22. Differences in feelings on… 30-10-2015 22 Talking about diabetes & treatment Discussing worries/concerns Maintaining blood sugar Having enough time to talk about lifestyle changes 32 27 32 43 37 54 44 44 46 43 50 43 43 40 3 10 5 1 7 1 6 21 17 19 6 12 1 10 Very positive Positive Indifferent Anxious
  23. 23. Differences in feelings on ideal drug… 30-10-2015 23 18% 5% 2% 1% 0% -3% -8% -10% -15% -19% -30% -20% -10% 0% 10% 20% 30% Injectable by you/physician* Treats several conditions* Minimal negative side effects Helps manage blood pressure Taken by mouth Maintains normal cholesterol levels Promotes weight loss that is meaningful* Once a Day* Promotes consistent weight loss* Helps manage blood sugar* Percentage of Patients minus Clinicians Saying Medication Attribute is “Very Important” or “Extremely Important” (Top 2 Box) +/-10% was judged to be threshold of clinically meaningful differences between patients and clinicians Patients rate more important than do clinicians *Differences statistically significant at 95% CI Patients rate less important than do clinicians Patients rate similarly important as do clinicians
  24. 24. Differences in meaningful weight loss 30-10-2015 24 *Differences statistically significant at 95% CI 1% 5% 10% 31% 52% 2% 11% 38% 39% 10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1-2% 2-3% 4-5% 6-10% >10% PWD Clinicians PercentageofRespondents PWD 5x more likely than Clinicians to say >10% PWD similarly likely as Clinicians to say 6-10% Neither PWD nor Clinicians likely to say 1- 2% PWD half as likely to say 2-3%; one-quarter as likely to say 4-5% In 6 months…
  25. 25. 26% 30% 12% 31% 12% 40% 23% 25% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 6 Mos. 12 Mos. 2 Yrs. > 2 Yrs. PWD (n=1819) Clinicians (n=1406) Differences in meaningful weight loss 30-10-2015 25 *Differences statistically significant at 95% CI time to keep the weight off PercentageofRespondents PWD similarly likely as clinicians to say >2 Yrs. PWD half as likely as clinicians to say 2 Yrs. PWD twice as likely as clinicians to say 6 Mos. PWD similarly likely as clinicians to say 12 Mos.
  26. 26. Discussion 30-10-2015 26 Limitations: • statistical comparison of differences is not possible • similar versus identical questions • inclusion of T1DM could not be ruled out • conclusions on causality are not possible • respondents drawn from online surveys • respondents seem to be more educated than average • sensitivity analyses confirmed valid survey results • country level differences most likely based on: • demographics • availability of medicines • standards of care
  27. 27. Conclusions 30-10-2015 27 • differences between perceptions of HCP and PWD regarding T2DM disease management • for HCP managing weight is most challenging, not so for PWD • less concerned for modifiable risk factors • unaware of relationship with long-term complications • HCP overestimate PWD’s anxiety with self injection • HCP underestimate PWD’s concerns about adherence • more than half PWD consider only weight loss > 10 % as meaningful and stresses on short-term goals • Ineffective communication perhaps contribute in these differences of perceptions  Need for further education and better communication
  28. 28. Acknowledgements 30-10-2015 28 Peter Schwarz Anne-Marie Felton Michael Cobble Ayeza Bonilla Islas Johan Wens

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