Approach to fears and concerns of type 2 diabetes mellitus patients in consultation: doctor and patient perspectives
DOI:
https://doi.org/10.32385/rpmgf.v41i3.13994Keywords:
Type 2 diabetes mellitus, Complications, DistressAbstract
Introduction: Type 2 diabetes mellitus is a chronic disease that requires special medical follow-up, which involves understanding the stress of living with it.
Objectives: To study the concerns and fears of individuals with type 2 diabetes mellitus (T2DM) and to compare their approach by the general and family medicine physician (GFM) to T2DM expectations.
Methods: Multifaceted observational study, qualitative-quantitative, initially interviewing PDM2 and questioning in specific conversation networks to understand concerns and fears. Using Excel, a thematic content analysis was conducted inductively, with all issues resolved by consensus. A similar questionnaire was conducted in MGF in specific conversation networks and to PDM2 in four Family Health Units (USF), PMD2s, and USF conveniently chosen.
Results: From interviews with 40 PDM2 52.5% women, 35.0% over 65 years old, and 32.5% under 50 years old, four main themes emerged: fear of complications, stress, concerns about medical care, and worries regarding medication. The second phase, with interviews conducted by the same researcher in 44 PMD2, showed no significant differences in the themes according to the studied sociodemographic variables. For 97.7% of the PDM2, addressing these topics in consultations would improve the control of diabetes. All interviewed PDM2 stated no questioning about the complications/consequences of the disease, stress from T2DM, and concerns related to medical care. For the same questions, 44.3%, 62.5%, and 70.5% of FDs reported not being asked about them. In concerns about medication, 93.2% of the PDM2 expressed not being questioned, and 25.0% of the FDs stated not asking about it.
Discussion and Conclusion: The approach in the consultation of FDs regarding the four main themes—concerns about complications, factors of stress/suffering, worries about medical follow-up, and fears regarding medication—has not yet been studied in the Person-Centered Medicine perspective. This approach by GPs could potentially improve the management of PMD2 patients.
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References
1. International Diabetes Federation. IDF diabetes atlas 2021 [homepage]. 10th ed. Brussels: IDF; 2021. Available from: https://diabetesatlas.org/atlas/tenth-edition/
2. Barreto M, Kislaya I, Gaio V, Rodrigues AP, Santos AJ, Namorado S, et al. Prevalence, awareness, treatment and control of diabetes in Portugal: results from the first National Health examination Survey (INSEF 2015). Diabetes Res Clin Pract. 2018;140:271-8.
3. Benmaamar S, Lazar N, El Harch I, Maiouak M, Qarmiche N, Otmani N, et al. Depression and anxiety in patients with diabetes in a Moroccan region. Encephale. 2022;48(6):601-6.
4. Basiri R, Seidu B, Rudich M. Exploring the interrelationships between diabetes, nutrition, anxiety, and depression: implications for treatment and prevention strategies. Nutrients. 2023;15(19):4226.
5. Maimaitituerxun R, Chen W, Xiang J, Xie Y, Kaminga AC, Wu XY, et al. Prevalence of anxiety and associated factors among inpatients with type 2 diabetes mellitus in China: a cross-sectional study. Psychiatr Q. 2023;94(3):371-83.
6. Pereira FO. Aspectos psicológicos de pessoas que padecem de diabetes mellitus [Psychological aspects of people suffering from diabetes mellitus]. Rev Psicol Divers Saúde. 2021;10(1):9-25. Portuguese
7. Svenningsson I, Björkelund C, Marklund B, Gedda B. Anxiety and depression in obese and normal-weight individuals with diabetes type 2: a gender perspective. Scand J Caring Sci. 2012;26(2):349-54.
8. Amorim IL, Coelho R. Diabetes mellitus tipo 2 e sintomas psicopatológicos [Type II diabetes mellitus and psycopathological symptoms]. Psicol Saúde Doenç. 2008;9(2):319-33. Portuguese
9. Um YH, Han KD, Kim TW, Jeong JH, Hong SC, Seo HJ. Does panic disorder increase the risk of cardiovascular diseases in diabetics? A nationwide population-based study. J Affect Disord. 2023;325:604-10.
10. Co MA, Tan LS, Tai ES, Griva K, Amir M, Chong KJ, et al. Factors associated with psychological distress, behavioral impact and health-related quality of life among patients with type 2 diabetes mellitus. J Diabetes Complications. 2015;29(3):378-83.
11. Ortiz M, Ortiz E, Gatica A, Gómez D. Factores psicosociales asociados a la adherencia al tratamiento de la diabetes mellitus tipo 2 [Psychosocial factors associated with adherence to treatment of type 2 diabetes mellitus]. Ter Psicol. 2011;29(1):5-11. Spanish
12. Costa PA, Oliveira Neta MS, Azevedo TF, Cavalcanti LT, Rocha SR, Nogueira MF. Emotional distress and adherence to self-care activities in older adults with diabetes mellitus. Rev Rene. 2022;23:e72264.
13. Santos S, Beça H, Mota CL. Qualidade de vida e fatores associados na diabetes mellitus tipo 2: estudo observacional [Quality of life and associated factors in type 2 diabetes mellitus: a cross-sectional study]. Rev Port Med Geral Fam. 2015;31(3):186-96. Portuguese
14. Carvalho PS, António CI. Sintomas psicopatológicos e vulnerabilidade ao estresse em uma amostra portuguesa de indivíduos com diabetes [Psychopathological symptoms and stress vulnerability in a portuguese diabetic sample]. Psicol Teor Prat. 2018;20(1):20-32. Portuguese
15. Pereira CS, Santiago LM, Silva IR, Ferreira P. Validation and cultural adaptation of the Problem Areas in Diabetes-5 (PAID-5) Scale to European Portuguese. Acta Med Port. 2024;37(1):36-41.
16. Meadows K, Steen N, McColl E, Eccles M, Shiels C, Hewison J, et al. The Diabetes Health Profile (DHP): a new instrument for assessing the psychosocial profile of insulin requiring patients – development and psychometric evaluation. Qual Life Res. 1996;5(2):242-54.
17. Mendes R, Santiago LM. Empatia e empoderamento na diabetes mellitus tipo 2 [The role of empathy and empowerment in type 2 diabetes]. Rev Port Med Geral Fam. 2022;38(5):461-72. Portuguese
18. Sousa S, Pereira AM, Santiago LM. Patient-centered medicine and self-care of patients with type 2 diabetes: a cross-sectional study. Acta Med Port. 2024;37(1):3-9.
19. Ribeiro AI, Launay L, Guillaume E, Launoy G, Barros H. The Portuguese version of the European Deprivation Index: development and association with all-cause mortality. PLoS One. 2018;13(12):e0208320.
20. Lamnisos D, Lambrianidou G, Middleton N. Small-area socioeconomic deprivation indices in Cyprus: development and association with premature mortality. BMC Public Health. 2019;19(1):627.
21. Pinto DM, Santiago LM, Maurício K, Silva IR. Health profile and medication adherence of diabetic patients in the Portuguese population. Prim Care Diabetes. 2019;13(5):446-51.
22. Kalra S, Jena BN, Yeravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab. 2018;22(5):696-704.
23. Zanchetta FC, Trevisan DD, Apolinario PP, Silva JB, Lima MH. Clinical and sociodemographic variables associated with diabetes-related distress in patients with type 2 diabetes mellitus. Einstein. 2016;14(3):346-51.
24. Hu Y, Li L, Zhang J. Diabetes distress in young adults with type 2 diabetes: a cross-sectional survey in China. J Diabetes Res. 2020;2020:4814378.
25. Tanenbaum ML, Kane NS, Kenowitz J, Gonzalez JS. Diabetes distress from the patient’s perspective: qualitative themes and treatment regimen differences among adults with type 2 diabetes. J Diabetes Complications. 2016;30(6):1060-8.
26. Morais HC, Costa AD, Oliveira JB, Ribeiro TF, Santos DB, Barros IM, et al. Sofrimento emocional relacionado ao diabetes mellitus tipo 2: análise na atenção primária à saúde [Emotional suffering related to type 2 diabetes mellitus: analysis in primary health care]. Ciênc Cuid Saúde. 2020;19:e50372. Portuguese
27. Cruz RS, Leitão CE, Ferreira PL. Determinantes do estado de saúde dos diabéticos [Determinants of diabetic’s health status]. Rev Port Endocrinol Diabetes Metab. 2016;11(2):188-96. Portuguese
28. Hood MM, Reutrakul S, Crowley SJ. Night eating in patients with type 2 diabetes: associations with glycemic control, eating patterns, sleep, and mood. Appetite. 2014;79:91-6.
29. Abade MR, Santo Amaro J. Associação entre a adesão à dieta mediterrânica e a qualidade de vida de pacientes diabéticos [Relationship between adherence to the Mediterranean diet and quality of life of diabetic patients]. Acta Port Nutr. 2019;18:20-4. Portuguese
30. Lyles A. Má alimentação causa 70% dos casos de diabetes tipo 2, revela novo estudo. In: Medscape [Internet]; 2023 Apr 27 [cited 2024 Feb 02]. Available from: https://portugues.medscape.com/verartigo/6509498
31. Agência Lusa. Cerca de 900 utentes recebem prescrição social que proporciona saúde e bem-estar [homepage]. Observador; 2023 Mar 9 [cited 2024 Feb 01]. Available from: https://observador.pt/2023/03/09/cerca-de-900-utentes-recebem-prescricao-social-que-proporciona-saude-e-bem-estar/
32. Shubrook JH, LaSalle J. Se a insulina é segura, do que os pacientes têm medo? In: Medscape [Internet]; 2017 Mar 22 [cited 2024 Feb 01]. Available from: https://portugues.medscape.com/verartigo/6501040?form=fpf
33. Ó D, Nascimento E. Grupo de estudos para a educação em diabetes [homepage]. Lisboa: Sociedade Portuguesa de Diabetologia; s.d. [cited 2024 Feb 01]. Available from: https://www.spd.pt/#/ged-educacao-e-diabetes
34. Cruz RS, Pocinho MT, Santiago LM, Ribeiro CF. A new tool for detecting adverse events associated with oral antidiabetic agents. Int J Latest Res Sci Technol. 2016;5(1):61-5.
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