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The management of type 2 diabetes usually begins with lifestyle changes to improve people’s diet and increase their physical activity. Type 2 diabetes is a condition that changes over time, meaning that most people will eventually require oral and injectable medications, including insulin. People with type 2 diabetes can feel anxious about these treatments, which can contribute to delaying starting these treatments once clinically indicated, leading to complications and poorer outcomes.^1-6

Healthcare professionals (HCPs) play an important role in informing, supporting and empowering people with type 2 diabetes to feel comfortable with changes to their diabetes treatment.^{1-3, 7-9} To do so they need to understand the perspectives of people with type 2 diabetes and have the necessary tools to support them.

This project was designed to explore perceptions of the changing nature of diabetes and its treatment over time among people with type 2 diabetes and healthcare professionals (HCPs).

The centrepiece of this project is a survey of 405 people with type 2 diabetes and 408 HCPs (specialist doctors, primary care doctors and diabetes nurses where available) in eight countries: Brazil, China, Germany, India, Russia, Saudi Arabia, Turkey and the US.

By surveying both people with type 2 diabetes and HCPs, we sought to gain an understanding of whether and where there are differences in their views. The survey was followed by a series of interviews with a range of experts to explore the findings of the survey and contribute to identifying actionable change.

The key findings of this project are:

• The progressive nature of type 2 diabetes can be a powerful motivator for people to avoid or delay complications.
• There is scope for more initial and on-going training in communication for HCPs, to improve their ability to understand and motivate people with type 2 diabetes.
• Emotional support for people with type 2 diabetes is lacking, with limited time the main barrier to delivering this care.
• Nurses are seen as an important part of the multidisciplinary team and can be particularly effective at providing emotional support to people with type 2 diabetes.
• Family and friends are important contributors to the motivation of people with type 2 diabetes, but it can be challenging for HCPs to reach or engage them.
• Peer support groups can be a useful source of support for people with type 2 diabetes.
• HCPs may overestimate negative attitudes to certain treatments and even exacerbate those feelings if treatments are used as a “threat”.

This report presents the findings of this research project, which have been summarised into key policy and practice take aways.

Footnotes:

1. Cosson E, Mauchant C, Benabbad I, Le Pape G, Le Bleis M, Bailleul F, Lalau JD. Perceptions of insulin therapy in people with type 2 diabetes and physicians: a cross-sectional survey conducted in France. Patient Prefer Adherence. 2019 Feb 11;13:251-260. doi: 10.2147/PPA. S181363. PMID: 30804666; PMCID: PMC6375534.

2. Kruger DF, LaRue S, Estepa P. Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes Metab Syndr Obes. 2015 Jan 16;8:49-56. doi: 10.2147/ DMSO.S71923. PMID: 25653546; PMCID: PMC4303400.

3. Stuckey H, Fisher L, Polonsky WH, Hessler D, Snoek FJ, Tang TS, Hermanns N, Mundet- Tuduri X, da Silva MER, Sturt J, Okazaki K, Cao D, Hadjiyianni I, Ivanova JI, Desai U, Perez- Nieves M. Key factors for overcoming psychological insulin resistance: an examination of patient perspectives through content analysis. BMJ Open Diabetes Res Care. 2019 Dec 11;7(1):e000723. doi: 10.1136/bmjdrc-2019-000723. PMID: 31908792; PMCID: PMC6936574.

4. Li J, Qiu X, Yang X, Zhou J, Zhu X, Zhao E, Qiao Z, Yang Y, Cao D. Relationship between Illness Perception and Depressive Symptoms among Type 2 Diabetes Mellitus Patients in China: A Mediating Role of Coping Style. J Diabetes Res. 2020 Oct 15;2020:3142495. doi: 10.1155/2020/3142495. PMID: 33123596; PMCID: PMC7585654.

5. Maor M, Zukerman G, Amit N, Richard T, Ben-Itzhak S. Psychological well-being and adjustment among type 2 diabetes patients: the role of psychological flexibility. Psychol Health Med. 2021 Feb 11:1-12. doi: 10.1080/13548506.2021.1887500. Epub ahead of print. PMID: 33573400.

6. Blonde L, Aschner P, Bailey C, Ji L, Leiter LA, Matthaei S; Global Partnership for Effective Diabetes Management. Gaps and barriers in the control of blood glucose in people with type 2 diabetes. Diab Vasc Dis Res. 2017 May;14(3):172-183. doi: 10.1177/1479164116679775. Epub 2017 Feb 1. PMID: 28467203; PMCID: PMC5418936.

7. Chew BH, Shariff-Ghazali S, Fernandez A. Psychological aspects of diabetes care: Effecting behavioral change in patients. World J Diabetes. 2014 Dec 15;5(6):796-808. doi: 10.4239/wjd. v5.i6.796. PMID: 25512782; PMCID: PMC4265866.

8. Jones A, Vallis M, Cooke D, Pouwer F. Working Together to Promote Diabetes Control: A Practical Guide for Diabetes Health Care Providers in Establishing a Working Alliance to Achieve Self-Management Support. J Diabetes Res. 2016;2016:2830910. doi: 10.1155/2016/2830910. Epub 2015 Nov 22. PMID: 26682229; PMCID: PMC4670648.

9. Seehusen DA, Fisher CL, Rider HA, Seehusen AB, Womack JJ, Jackson JT, Crawford PF, Ledford CJW. Exploring patient perspectives of prediabetes and diabetes severity: a qualitative study. Psychol Health. 2019 Nov;34(11):1314-1327. doi: 10.1080/08870446.2019.1604955. Epub 2019 Apr 23. PMID: 31012328.