Patient perceptions of their glycemic control and its influence on type 2 diabetes outcomes: an international survey of online communities

Abstract

Purpose: This study aimed to assess awareness of glycated hemoglobin (A1C) testing and targets, perceived level of glycemic control and risk of complications, attitudes toward medications and self-management, and regimen-related distress in an international sample of patients with type 2 diabetes (T2D).

Methods: The descriptive study used a single time-point survey of adults in online health communities in the USA, Canada, the UK, Germany, Spain, and Mexico, who self-reported T2D diagnosed by a physician.

Results: In total, 661 patients participated. Awareness of their A1C value at last test varied considerably between countries (42%-89%), as did awareness of having an A1C target (26%- 70%). Self-reported A1C values were similar across US, Canadian, and European respondents (mean, 6.8%-7.3%). Approximately two-thirds of respondents from these countries (66%-71%) reported that their T2D was very or fairly well controlled, and few (5%-15%) expected to experience serious complications within 1 year. However, many respondents expected to experience microvascular (rather than macrovascular) complications in this time frame (eg, nerve pain, 5%-47%). Self-reported adherence to oral medication was generally high, with most respondents (86%-98%) taking their pills or tablets as directed by their healthcare provider, although for insulin injections adherence was lower in the USA (71%) and Mexico (78%) than in the other countries (86%-95%). The majority of respondents across countries (71%-79%) reported that taking injectable medications was not at all or a little burdensome. Respondents across countries appeared to be reasonably confident that they could adequately manage their blood sugar levels; despite this, a sizeable minority (21%-35%) had clinically significant levels of regimen-related distress.

Conclusion: Limited patient awareness of their A1C value and the potential complications of poorly controlled T2D, particularly regarding cardiovascular complications, may be a widespread problem. Furthermore, greater patient support may be needed to improve self-management of T2D and to reduce regimen-related distress.

Keywords: diabetes complications; diabetes mellitus; glycated hemoglobin; self-management; surveys; type 2.

Figure 1

Participant perceptions of diabetes control and complications (part 1). Notes: Responses to survey questions. (A) To what extent do you believe your diabetes is under control? (B) If you were to stay at your current level of diabetes control, for how long do you think you could avoid any serious complications due to your diabetes?

Figure 2

Participant perceptions of diabetes control and complications (part 2). Notes: Responses to survey questions. (A) What do you think is likely to happen to you in the short term (within 1 year) if your diabetes stays at the same level of control? (B) What do you think is likely to happen to you in the long term (after 5 years) if your diabetes stays at the same level of control?

Figure 3

Participant behaviors relating to diabetes management. Notes: Responses to survey questions. (A) How often do you miss or skip appointments, for any reason, with a healthcare provider to discuss or review your diabetes? (B) What has your doctor told you to do to manage/control your diabetes better? (C) Do you always take your pills or tablets as directed by your healthcare provider? (D) Do you always take your insulin as directed by your healthcare provider?

Figure 4

Participant perceptions of diabetes medications. Notes: Responses to survey questions. (A) How burdensome would you say it is to take your injectable medication for your type 2 diabetes? (B) How important are medicines in helping you achieve your diabetes goals?

Figure 5

Participant attitudes toward diabetes self-management. Notes: Responses to survey statements. (A) I am confident that I can avoid serious problems due to low blood sugar when I am alone. (B) I spend so much time worrying about the possibility of a low blood sugar episode that it interferes with my ability to do the things I really want to do. (C) To avoid serious problems with low blood sugar, I tend to keep my blood sugars higher than I probably should.