Effects of cardiovascular disease risk communication for patients with type 2 diabetes on risk perception in a randomized controlled trial: the @RISK study

Abstract

Objective: Patients with type 2 diabetes mellitus (T2DM) underestimate their risk of developing severe complications, and they do not always understand the risk communication by their caregivers. The aim of this study was to investigate the effects of an intervention focused on the communication of the absolute 10-year risk of developing cardiovascular disease (CVD) in patients with T2DM.

Research design and methods: A randomized controlled trial was performed in T2DM patients newly referred to the Diabetes Care System (DCS) West-Friesland, a managed-care system in the Netherlands. The intervention group (n = 131) received a six-step CVD risk communication. Control subjects (n = 130) received standard managed care. The primary outcome measure was appropriateness of risk perception (difference between actual CVD risk calculated by the UK Prospective Diabetes Study risk engine and risk perception). Secondary outcome measures were illness perceptions, attitude and intention to change behavior, satisfaction with the communication, and anxiety and worry about CVD risk. Patients completed questionnaires at baseline, at 2 weeks (immediately after the intervention), and at 12 weeks.

Results: Appropriateness of risk perception improved between the intervention and control groups at 2 weeks. This effect disappeared at 12 weeks. No effects were found on illness perceptions, attitude and intention to change behavior, or anxiety and worry about CVD risk. Patients in the intervention group were significantly more satisfied with the communication.

Conclusions: This risk communication method improved patients' risk perception at 2 weeks but not at 12 weeks. Negative effects were not found, as patients did not become anxious or worried after the CVD risk communication.

Figure 1

Design of the randomized controlled trial on the effects of risk communication in patients with T2DM.

Figure 2

A–C: Agreement between the UKPDS (x-axis) and risk perception (y-axis) (measured by means of the question, “If the mean risk of developing CVD in the next 10 years for men with diabetes is 20 of 100 men and for women 15 of 100 women, how would you rate your risk of developing CVD in the next 10 years?”) at baseline (A), 2 weeks (B), and 12 weeks (C), respectively. Each dot represents one patient. ○, control group; □, intervention group; – — –, linear regression line for the intervention group; linear regression line control group; - - - - - diagonal line, ideal situation wherein UKPDS = risk perception.