Diabetics' A1c, cholesterol levels improve when they join in treatment decisions

Primary care physicians who involve diabetic patients in making decisions about their treatment will find improved control among this group's hemoglobin A1c and low-density lipoprotein cholesterol levels, says the author of a new study. The challenge, however, is for doctors to find sufficient time during office visits to encourage patient participation.

"It's really important to document that our ability to make care more patient-centric and involve patients more in the decision-making process results in improved clinical outcomes. ... It actually makes a difference in reducing mortality and the development of complications from diabetes," said Michael Parchman, MD, MPH, lead author of the study in the September/October Annals of Family Medicine. He is a professor in family and community medicine at the University of Texas Health Science Center at San Antonio.

Dr. Parchman recommends that physicians ask diabetic patients open-ended questions during office visits to encourage a discussion about their health. He said doctors also could have patients write down their health concerns, then ask about them during their next office visit.

Researchers examined data on 141 diabetics 19 and older who were patients at five family physician offices affiliated with the South Texas Ambulatory Research Network. All patients had type 2 diabetes.

Participants were asked how often they prepare a list of questions for office visits and how frequently their doctor discusses the pros and cons of medical choices. Patients also were asked about their medication adherence, including if they ever forgot to take their medicine.

Researchers examined patients' hemoglobin A1c levels, systolic blood pressure and LDL cholesterol for 36 months.

The study found that patients who reported a higher level of participatory decision-making with their physicians were more likely to be active participants during medical visits. That led to greater medication adherence. The study describes participatory decision-making as a physician-patient partnership in which the doctor considers the patient's wants, needs and preferences before making a medical decision (link).

Patients who took medication as prescribed had improved control of glucose and lipid levels. Medication adherence, however, was not related to improvement in systolic blood pressure.

An estimated 23.6 million Americans had diabetes in 2007, according to the latest data from the American Diabetes Assn. About 90% had type 2 diabetes.

Adults with diabetes have heart disease death rates two to four times higher than people without the condition. The risk for stroke also is two to four times greater for diabetic adults.

"The more we can do as primary care physicians to encourage patients to be active in expressing their preferences regarding their care ... the better the outcomes will be," Dr. Parchman said.