ABSTRACT
In COVID vaccination stand-offs, what is "fact" for one is "fake" for another. Describing the effects of vaccines is counter-productive against positions or beliefs. Most patient-clinician interactions aren't this extreme. Yet, the issue of what types of things can productively be discussed remains. Broadly, shared decision making (SDM) discusses problems, options, and preferences. Yet one person's problem, "your blood sugar is too high" is not another's "I can't afford my insulin". It's not that they don't share priorities, what type of problem diabetes is, is different. For the clinician diabetes is the effects of excessive blood glucose, for the patient, the day-to-day impediment to life. SDM is unlikely to be productive unless the clinician can switch from talking about effects to situations. Otherwise, they're discussing fundamentally different things. Using a directed-content analysis based on Purposeful SDM and McKeon's interpretive-orientations model we identified different types of things that are problems, options, and preferences in video-recorded encounters. Patients and clinicians are frequently talking about different types of things. E.g. The clinician describing a problem as the effects of osteoporosis, and the patient expressing the problem as a position "I won't take medicines". It is unproductive when this is unrecognized in conversation. Types of "things" that are problems, options, and preferences are: Effects, People's positions, Situations, and Truths. For example, a problem may be located in competing positions, where options are alternative positions, and a preference is the acceptability of adopting another position. Alternatively, a problem may be the effects of illness, with options being counter effects with side effects, and preferences reactions to these effects. While discussing the same topic, patients and clinicians may be talking about different things. Evidence, decision aids, and medical science mostly discuss effects. Inclusiveness of other types of "things" is important in SDM. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
INTRODUCTION: Lockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: We performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown. RESULTS: In total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: -0.39% (-4.3 mmol/mol) (p<0.0001 and type 2 diabetes: -0.62% (-6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001). CONCLUSIONS: An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.