Den här studien har en frågeställning om hur insättande av läkemedel vid typ 2 diabetes påverkar hur patienterna uppfattar sin behandling i relation till sina levnadsvanor.
Det finns ingen sådan studie sedan tidigare och resultatet är intressant och vägledande för de som arbetar med patienter med typ 2 diabetes och de riktlinjer som gäller.
Susanne Andersson, docent i vårdvetenskap
FoU-strateg och innovationsledare FoU primär och nära vård Skaraborg
Västra Götalandsregionen, Skövde
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https://www.tandfonline.com/doi/full/10.1080/17482631.2024.2389575?af=R
From unwelcome to supportive. Patients’ conceptions of being prescribed a glucose-lowering drug at type 2 diabetes diagnosis – a phenomenographic study, Sofia Dalemo, Yvonne Carlsson, Johan Alsterhag, Susanne Andersson
ABSTRACT
Purpose
Guidelines recommend starting glucose-lowering drug upon type 2 diabetes mellitus diagnosis together with lifestyle changes. Lifestyle changes are as essential as the drug, earlier recommendations allowed some months of lifestyle changes while being drug-free. Prescription on diagnosis may interfere with patients’ understanding and motivation for lifestyle changes if they cannot evaluate the effect on blood glucose.
Methods
A phenomenographic approach and interviews were conducted with patients who started a glucose-lowering drug at diagnosis.
Results
Three qualitatively different conceptions of being prescribed glucose-lowering drugs in connection to type 2 diabetes mellitus diagnosis were found: “Drugs as something unwelcome,” “Drugs as a support,” and “Drugs as a means to reach the goal”. These conceptions range broadly from drugs as unwelcome to drugs as a support for lifestyle changes and an opportunity to influence the course of the lifelong disease to reach a goal.
Conclusions
This study has identified various perspectives of patients’ understanding of the role of lifestyle changes in managing their disease. The patients undergo a process, and the perspectives vary, providing a more extensive and nuanced understanding.
It is, therefore, impossible to apply a routine protocol and a person-centred approach is required when prescribing a glucose-lowering drug.
From the article
Introduction
The number of patients with type 2 diabetes mellitus (T2DM) has increased globally over the past three decades, making it a significant healthcare problem (Chen et al., Citation2011). It is estimated that 783 million adults will have diabetes by 2045 (Sun et al., Citation2022). This trend can also be seen in Sweden, where approximately 5% of the population has known T2DM diabetes (The Swedish National Diabetes Register, Citation2022). An underlying reason is the increasing number of elderly people, as T2DM susceptibility increases with age. T2DM is often associated with lifestyle-related factors but also with genetic factors (International Diabetes Federation, Citation2021). The basis of its treatment is lifestyle intervention, such as a healthy diet, weight loss, and improved physical activity, often in combination with pharmacological treatment (International Diabetes Federation, Citation2021).
T2DM is a serious disease that can lead to severe complications and premature death (Goff et al., Citation2007; Norhammar et al., Citation2016). Early treatment of elevated glucose levels leads to fewer complications and reduced mortality (UK Prospective Diabetes Study UKPDS Group, Citation1998). Metformin, a glucose-lowering drug, has a preventive effect on cardiovascular disease, which is another reason to prescribe the drug (Holman et al., Citation2008). The Swedish Medical Products Agency recommends starting metformin immediately upon a T2DM diagnosis (Swedish Medical Products Agency, Citation2017). The same guidelines also recommend increased physical activity and necessary lifestyle changes because lifestyle changes are as essential in managing T2DM as the drug. Previous guidelines offered patients a few months to introduce and evaluate lifestyle changes’ effect on blood glucose levels while being drug-free before starting drug treatment (International Diabetes Federation, Citation2021; National Board of Health and Welfare, Citation1996).
In Sweden, patients with T2DM usually receive care at primary healthcare centres, where they meet specialist diabetes nurses and general practitioners. The diabetes nurse primarily educates patients with T2DM and strengthens their self-management ability regarding diet, physical activity, and lifestyle (Kjellsdotter et al., Citation2020). To meet the different needs of patients, person-centred care is appropriate with a partnership that incorporates listening to the patient’s story, sharing information, and joint decision-making (Ekman et al., Citation2011). For patients with recently diagnosed T2DM, an initial period focused on lifestyle changes can offer a pedagogical experience to evaluate the effect of these changes on blood glucose levels while free from drugs. Reflecting on and experiencing a direct impact on blood glucose levels could promote learning and increased awareness of one’s responsibility for healthy lifestyle changes (Johansson et al., Citation2016).
Having T2DM changes one’s living conditions. To manage the new situation with illness and the consequences for the current life situation and health in the longer term, the illness and treatment must be integrated into daily life (Hörnsten et al., Citation2011). This can be understood as a process of learning grounded in the new life situation (Berglund, Citation2011; Johansson et al., Citation2016; Kneck et al., Citation2011).
Although the effects of glucose-lowering drugs on complications and mortality are well studied, there is a lack of studies on how patients’ conceptions of being prescribed a glucose-lowering drug in direct connection to a T2DM diagnosis vary. There are concerns that prescription on diagnosis may interfere with patients’ understanding of the role of lifestyle changes in managing their disease. By understanding how patients perceive being prescribed a drug and simultaneously implementing the necessary lifestyle changes, healthcare professionals can adapt their practice to the patients’ responses to the new situation. This study can better highlight patients’ conceptions of being prescribed a glucose-lowering drug while simultaneously implementing necessary lifestyle changes and lead to healthcare professionals providing person-centred care.
Therefore this study aims to describe variations in patients’ conceptions of being prescribed a glucose-lowering drug in direct connection to a T2DM diagnosis, and how it affects the motivation for lifestyle changes.
Discussion
Studies of patients’ experiences of being prescribed a glucose-lowering drug in connection with a T2DM diagnosis affect the motivation for lifestyle changes have not previously been described in the literature, so the current study fills this gap. An interesting outcome of this study was the broad range of patients’ conceptions on being prescribed a glucose-lowering drug. It illuminates a spectrum from “Drugs as something unwelcome” to “Drugs as a support” to “Drugs as a means to reach the goal”.
The first conception was that the drug was unavoidable and unwelcome. Many patients have previously seen themselves as someone who does not use medication, so starting with a glucose-lowering drug is a big deal, although unwelcome. The glucose-lowering drug was not described as a miracle cure. A contrast may be that as a patient, it is more important to be understood as a person, a patient with T2DM, not primarily cured (Ekman et al., Citation2011). This perspective differs from physicians and nurses, who primarily see their tasks as curing diseases (Anden et al., Citation2005). When the patients tried to make sense of being prescribed a glucose-lowering drug in connection with the diagnosis, they described it as unwelcome and accompanied by demands to change their lifestyle. Many patients do not realize that lifestyle changes are as essential treatment as the drug.
In this study, the patients perceived that the medical side effects could be troublesome, and that there was always a risk of side effects that may appear now or later. This led to some scepticism about the drug. Another study showed that simply being prescribed long-term drug treatment seems to have a strong influence on both identity and self-perception. Shared decision-making when starting drug treatment seems to be important for the outcome (Hultberg & Rudebeck, Citation2017). A person-centred approach to care sets the person’s conceptions at the centre, and the narrative may be the starting point for partnership (Ekman et al., Citation2011). Furthermore, how patients make sense of their new situation with a glucose-lowering drug is affected by experiences in life; thus, it is impossible to apply a routine treatment protocol when starting medical treatment. Therefore, healthcare professionals have a crucial role to play in telling and listening to the patients in an open manner as a way to create a common understanding (Ekman et al., Citation2011) and not only be focused on the laboratory levels of the disease (Sørensen et al., Citation2020). In this study, the experience of not participating in the decision-making process may have been reinforced by the COVID-19 pandemic when physical meetings were limited (Florin et al., Citation2008; Strobel et al., Citation2023).
The second conception is that patients experience the glucose-lowering drug as supportive, which motivates and inspires the implementation of essential lifestyle changes. The patients have already worked their way through the process and reached the level at which taking medicine is no longer an issue, as medication has already been incorporated into daily life (Hultberg et al., Citation2021).
Taking a life-long drug can be seen as a daily reminder of the disease. The medication times become like a mealtime schedule that gives structure to their food intake and physical activities. Another Swedish study showed that reflecting on the drug and its effects contributes to the understanding of the disease’s complexity. This understanding increases the motivation to be responsible for the treatment and implementation of new habits (Kjellsdotter et al., Citation2020).
The third and last conception is described by the patients as an opportunity to reflect on and influence the course of the lifelong disease. Drugs are one of several ways to reach set goals. Lifestyle habits such as a healthy diet and increased physical activity are essential as the drug in managing the disease. The consequences for health in the longer term mean that the disease and its treatment must become a natural part of life; it must be integrated with the person one is (Hörnsten et al., Citation2011). To manage the new situation of having T2DM with changed life conditions, a process of learning grounded in the new life situation must occur (Berglund, Citation2011; Johansson et al., Citation2016; Kneck et al., Citation2011). Most patients with T2DM in Sweden are registered in the Swedish National Diabetes Register. Through the register, it is possible to follow, for example, the average level of blood glucose (HbA1c) at different healthcare centres. These monitoring statistics may contribute to healthcare professionals feeling pressured to introduce medication for blood glucose control in connection with the diagnosis. The monitoring statistics may also contribute to healthcare professionals not presenting a healthy diet and increased physical activity as being as important as the glucose-lowering drug.
Läs hela artikeln pdf free
https://www.tandfonline.com/doi/full/10.1080/17482631.2024.2389575?af=R
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