Dr William Polonsky on Diabetes Patients' Treatment Satisfaction and Insulin Adherence

Diabetes patients will be more satisfied with treatment when they perceive benefits and will continue treatment when physicians keep in contact and point out the progress, says William Polonsky, PhD, CDE, president of the Behavioral Diabetes Institute and associate clinical professor at University of California, San Diego.

Transcript (slightly modified)
What has been learned about T2D patient satisfaction with continuous glucose monitoring (CGM), and how should a physician interpret these findings?
We’re presenting data here, at the American Diabetes Association Scientific Sessions, that examines CGM satisfaction in type 2 diabetes in the Diamond study.

What we find are very, very high levels of treatment satisfaction, in fact higher than any previous study that I’m aware of. We find that the satisfaction is equivalent to what we see in folks with type 1 diabetes, so the news is very good. In the data that we are going to be presenting here, the major difference between the type 1s and the type 2s is that type 2s actually perceive somewhat more benefits to CGM than type 1s. Those benefits really have to do with feeling that they’ve learned something new about how their own actions affect blood sugar, things they didn’t know before, things that often people with type 1 are probably very conversant with, given their experience blood glucose monitoring and probably living longer lives with diabetes as well.

I hope this is really striking to healthcare providers as they reticent about the use of CGM data for type 2s, that at least from the point of personal treatment satisfaction there’s a huge amount of enthusiasm.  Also, we saw in the Diamond trial, particularly in the type 2 population, people didn’t stop using this device, they kept using it and the enthusiasm was very high.

What advice would you give to physicians to help them improve the doctor-patient conversation around insulin adherence?
My recommendation for healthcare providers when they have type 2 patients on insulin that they suspect to be struggling with following recommendations—they may be reluctant to titrate up to the necessary dose, they may be falling off, they may be discontinuing—the single most important strategy is to stay in touch with patients.

When people fall off the wagon in some degree, it’s because they feel like they’re on their own with their diabetes and insulin. Literally more frequent contact with patients, whether that means more frequent visits or text messaging. Just being in touch and for the patient to know that there is someone out there who is rooting for you or holding you accountable, can make a huge different. Another important way that could help people stay active with their insulin and not fall off the wagon, is to provide them with some sort of ongoing, tangible feedback that what they’re doing is actually making a difference; whether that’s through glucose monitoring or graphical displays of A1Cs. There is unfortunately a tendency for people to discontinue or to be reluctant about titrating because they just don’t perceive any benefit. They have concerns that if they take more insulin it must be bad and if I take more insulin it must be heathier.

Those discussions need to take place with a healthcare provider to help people understand that’s just not true. To help people see and point out where there are tangible benefits is true for any of this, if you are trying to maintain a positive behavior change, odds are pretty good that you’ll keep it going if you have an ongoing, positive and tangible sense that what you’re doing is making a difference.

When we can help people see that, “remember when you used to be more tired than you are now?” or “remember when your mood wasn’t as good and your blood sugars are better.”  When we stay in contact with people and help them see that their actions are making a difference is probably the most effective way we can help people be successful and stay with recommendations.
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