Capsule Commentary on Fairchild et al., Patients’ future expectations for diabetes and hypertension treatments: “Through the diet… I think this is going to go away ”
This qualitative study by Fairchild et al.1 examined patient beliefs regarding diabetes and hypertension medical treatment, hope for potentially being cured or coming off medications and expectations for provider communication about the likely duration of medication use. The authors found that most patients believed they could eventually come off their diabetes medications (78 %), largely because they hoped to change their lifestyle. Others hoped advances in medical science could cure their disease.
The authors interpreted this to mean that the patients need more education “in order to manage their expectations for current and future medications.” Among this group of well-controlled diabetics (A1c: 6.9 %), the majority believed that improving their lifestyle and losing weight could improve their diabetes and hypertension and that they might eventually be able to discontinue medications. This is a common message from primary care providers and is evidence-based. The majority of morbidly obese patients undergoing bariatric surgery experience remission of their diabetes2 and losing only 10 % of their weight can reduce progression to diabetes from glucose intolerance.3 While most patients do not lose weight and do not succeed in changing their lifestyle, the hope itself is not unrealistic and is both a positive message and also one that can help activate patients.
Nearly all patients answered yes to the researchers’ leading question, “before starting a new medicine for your diabetes and high blood pressure, would you like your doctor to tell you how long you’ll be on the medication?” Studies have universally found that patients desire more information from their providers, whether it is about diagnosis, prognosis or treatment, though most express high levels of satisfaction with the information provided.4 This study appears to suggest that patients are heeding their provider’s likely advice, that if they successfully lose weight and make other lifestyle changes, they may be able to come off their medications. Concluding that “providers should education patients on the natural history…in order to manage their expectations” seems a bit strong, since obesity has a profound impact on the natural history of diabetes and lifestyle management is central to guideline recommendations for diabetes management.5
Compliance with Ethical Standards
Conflict of interest
The authors have no conflict of interest with this article.
- 1.Fairchild PC, Nathan AG, Quinn M, Huang ES, Laiteerapong N. Patients’ future expectations for diabetes and hypertension treatments: “Through the diet… I think this is going to go away.” J Gen Intern Med. doi: 10.1007/s11606-016-3871-3
- 5.Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes self-management education and support in type 2 diabetes: A joint position dtatement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clin Diabetes. 2016;34(2):70–80.Google Scholar