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Original Research

Look Who’s (Not) Talking

Diabetic patients’ willingness to discuss self-care with physicians

  1. Elizabeth A. Beverly, PHD1,2,
  2. Om P. Ganda, MD1,2,
  3. Marilyn D. Ritholz, PHD1,2,3,
  4. Yishan Lee, MPS1,
  5. Kelly M. Brooks, BA1,
  6. Nina F. Lewis-Schroeder, MA1,2,
  7. Masakazu Hirose, MD1,2 and
  8. Katie Weinger, EdD1,2⇓
  1. 1Joslin Diabetes Center, Boston, Massachusetts
  2. 2Harvard Medical School, Boston, Massachusetts
  3. 3Children's Hospital, Boston, Massachusetts
  1. Corresponding author: Katie Weinger, katie.weinger{at}joslin.harvard.edu.
Diabetes Care 2012 Jul; 35(7): 1466-1472. https://doi.org/10.2337/dc11-2422
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Abstract

OBJECTIVE Nearly one-half of diabetic patients have glycated hemoglobin A1c (HbA1c) levels above recommended targets. Effective physician–patient communication improves glycemia and diabetes self-care; however, communication gaps may exist that prevent patients from discussing self-care problems with treatment providers.

RESEARCH DESIGN AND METHODS We assessed diabetic patients’ (n = 316, 85% white, 51% female, 71% type 2 diabetes, 59 ± 11 years old, 16 ± 3 years education, 19 ± 13 years diabetes duration, and HbA1c = 7.9 ± 1.4%) HbA1c, frequency of self-care, diabetes-related distress, depressive and anxiety symptoms, coping styles, diabetes quality of life, and self-care communication in the treatment relationship. Multivariate logistic regression models examined the main and interaction effects of health and psychosocial factors associated with patients’ reluctance to discuss self-care.

RESULTS Patients reported positive relationships with their doctors and valued honest communication; however, 30% of patients were reluctant to discuss self-care. Reluctant patients reported less frequent self-care (P = 0.05), lower diabetes quality of life (P = 0.002), and more diabetes-related distress (P = 0.001), depressive symptoms (P < 0.001), and anxiety symptoms (P = 0.001). Patients who reported elevated depressive symptoms, although not necessarily major depression, were more likely to be reluctant to discuss self-care (odds ratio [OR] 1.66 for 10-point change in t score; P < 0.001), whereas patients who were older (OR 0.78 for 10-year change; P = 0.05) and those who used more self-controlled coping styles (OR 0.78 for 10-point change; P = 0.007) were less likely to be reluctant.

CONCLUSIONS Awareness of elevated depressive symptoms is important in clinical practice given that these patients may be more reluctant to discuss self-care. Interventions and evidence-based approaches are needed to improve both depressive symptoms and physician-patient communication about self-care.

  • Received December 13, 2011.
  • Accepted March 12, 2012.
  • © 2012 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Diabetes Care: 44 (3)

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Look Who’s (Not) Talking
Elizabeth A. Beverly, Om P. Ganda, Marilyn D. Ritholz, Yishan Lee, Kelly M. Brooks, Nina F. Lewis-Schroeder, Masakazu Hirose, Katie Weinger
Diabetes Care Jul 2012, 35 (7) 1466-1472; DOI: 10.2337/dc11-2422

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Look Who’s (Not) Talking
Elizabeth A. Beverly, Om P. Ganda, Marilyn D. Ritholz, Yishan Lee, Kelly M. Brooks, Nina F. Lewis-Schroeder, Masakazu Hirose, Katie Weinger
Diabetes Care Jul 2012, 35 (7) 1466-1472; DOI: 10.2337/dc11-2422
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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.