Exploring barriers to improved treatment is necessary for better management of type 2 diabetes mellitus (T2DM). At diagnosis, differences in physicians’ and patients’ perceptions of important disease- and treatment-related issues might constitute such a barrier.
We conducted a 20-minute online survey in Brazil, Japan, India, Spain, UK and USA, enrolling 652 adult T2DM patients and 337 physicians (264 general practitioners [GPs], 73 specialists). Physicians were required to treat a minimum number of patients (GPs >50; specialists >100) and to spend at least 70% of their time per month in direct patient care.
Physicians and patients reported a mean duration of 23 min and 27 min, respectively, for the diagnosis consultation visit. During the visit, most time was spent discussing lifestyle changes and diet, the disease and its causes, and drug treatment (13-18% per category, depending on GP/specialist). 68% of the patients understood the importance of lifestyle interventions. In Japan, 23% of patients did not consider changes to their exercise regimen as being very important. Physicians had incrementally reduced expectations of adherence to lifestyle advice among >50-year-olds (36%), renally impaired patients (24%) and >80-year-olds (14%). Patients were more likely to follow dietary (51%) than exercise advice (40%). Health problems were the main reason (33%) given for not exercising, especially in the UK, where 52% of the physicians prescribed diet and exercise alone as first-line treatment, independent of patient profile. About half of the patients were advised to make lifestyle changes before receiving an anti-diabetic drug. At diagnosis, 23% of the patients (low: USA, 15%; high: UK, 37%) were not prescribed any medication, a decision that most patients perceived positively. Although 33% of all patients received initial drug treatment within a month, 58% of Japanese patients received drug treatment only after an average of 2 years.
Barriers to appropriate disease management are constituted already at the time of diagnosis of T2DM. Identification of such factors is instrumental to improving outcomes.