Perspectives on Diabetes Care

From Research to Practice: The Importance of Patient Perspectives

Mar 22, 2021, 10:16 AM

By Neesha Ramchandani, PhD, PNP, CDCES

“If you build it, they will come.” (Field of Dreams movie, 1989)

Or will they? In the movie, the answer was yes. But how about in diabetes care and education? 

There are many opportunities to develop tools of all sorts for various populations of people with all kinds of diabetes. But just because someone has a vision and builds something they think is wonderful does not mean it will be useful for the intended audience. For example, take telehealth for emerging adults with type 1 diabetes (T1D). Several years ago, I had the fabulous idea (or so I thought at the time) of building a web-based diabetes care center for people with T1D. It would be full service, and I would be able to see patients from anywhere. Fast forward a few years to my doctoral research, when I asked a group of emerging adults with T1D if they would prefer video visits over in-person visits. The answer from all was a resounding “No.”

It is important to ask the right questions, both in research and clinical practice, and truly listen to the answers so that appropriate interventions or services can be offered.

Stotz and colleagues did just that in their recently published article entitled Opportunities for interventions that address socioeconomic barriers to type 2 diabetes management: Patient perspectives (The Science of Diabetes Self-Management and Care, Feb 2021 e-pub ahead of print). The article is excellent and worth a read, since it has information applicable to all clinicians working with people affected by diabetes who face socioeconomic barriers to care.

The study participants discussed having difficulty implementing healthy eating strategies because of the socioeconomic barriers they faced. Their preferred intervention strategies to help overcome these barriers included:

• Socioeconomic-informed lifestyle interventions such as focusing on food resource management.
• Skill-building such as cooking healthy food and eating healthy on a budget and/or on the go.
• Group-based learning activities.
• Provision of additional resources such as meal delivery programs.

These interventions and more are discussed in detail in the article. I don’t want to give everything away here! 

This study demonstrates the importance of listening to your clients and working with them as partners in care to implement solutions that have better chances of success. When I worked in an urban hospital with a large population of patients with low socioeconomic status, I was horrified at how terribly the patients were doing with regards to their diabetes self-management. Meter downloads commonly showed blood sugars in the 200-400’s (mg/dl) range, and HbA1c values were above 9% more often than not. The prevailing provider mindset was that these patients could not do any better because of their circumstances. But if we as clinicians actually spent the time to find out why things are the way they are, and what the clients think might help, improvements could be (and were!) made.

So, what can you do to help your clients optimize their diabetes self-management? Among other things, this study highlights the importance of listening and treating them as partners in care instead of dictating to them. And if your clients have type 2 diabetse and low socioeconomic status, Stotz et al’s article has wonderful suggestions. 

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