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Daily self-care and long-term treatment goals: Is there a gap?


14 December 2005

Daily self-care and long-term treatment goals: Is there a gap?

Following up on yesterday’s post regarding the noncompliant pregnant woman, I thought it would be of some use to talk about the issue of patient motivation. So, as we digest the idea that Alzheimers is Diabetes Type 3, let’s ponder something else as well.

I found a pretty typical (has been performed pretty regularly over the past 20 years) study that was administered at the University Hospital of Basel, Switzerland in June of this year. The study, What are Disease perceptions and subjective treatment goals of insulin treated diabetic patients, was conducted to learn more about patient perceptions, concerns and treatment goals with diabetes. The sample was small, at 60 for “no insulin pump” Type 1’s, 42 insulin pumpers (Type 1) and 22 insulin dependent Type 2’s. The objective was to try and figure out what is most restricting or concerning to IDDM patients.

The authors at the outset, reflected today’s diabetes clinical care with the statement,

….patient empowerment and self management can increase their satisfaction and quality of life. [3,4} as well as metabolic control. Therefore, diabetes care is moving towards more patient centered care. Individual tailoring of the treatment goals to the patients’ own goal potentiates this autonomy.

That’s fine.

What they sussed out is this:
Disease perception
When asked open-ended questions about primary concerns patients were more concerned about the loss of freedom in their lives and QOL issues. Closed-ended questions produced responses that were more focussed on long-term issues such as fearing complications and major hypoglycemic episodes.

Treatment Goals
The main response for both Types was good blood glucose control and preventing complications.

In the end, the study speculates, “that for many patients, glucose control as a goal has become too detached from the original long-term goal.”

Doctors know that good to great metabolic control will be likely to give a person a reasonably high QOL without complications. This statement is absolutely true, and I can’t tell you how many times I have read variations of it in my lifetime. My question is this – at what cost to a person’s personal life? Why are QOL variables defined only in the long-term net and not in present time?

I remember interviewing a Type 2 insulin dependent woman for research and she told me that if she really did everything her doctor told her to do – she would have no time for living.

That statement has stuck with me for a long time.


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