CORONARY HEART DISEASE RISK PERCEPTIONS AND COMMUNICATION AMONG TYPE 2 DIABETES MELLITUS PATIENTS AND PRIMARY CARE PHYSICIANS

Patients with type 2 diabetes (T2DM) are at increased risk for coronary heart disease (CHD). Prior studies have documented that patients consistently overestimate their risk of CHD and other complications (Asimakopoulou et al., 2008; Frijling et al., 2004). However, no studies have examined patient-physician pairs in their estimation of T2DM patient risk for CHD. In addition, the degree of concordance between patient-physician pairs on their communication of CHD risk-related topics has also not been documented. This study examined: 1) the accuracy of patient and physician 10-yr CHD risk perceptions compared to absolute CHD risk estimations from the UKPDS Risk Engine and 2) proportions of patient-physician concordance on communication of CHD risk, blood glucose monitoring (SMBG), and cholesterol reduction during a routine office visit. The sample consisted of 83 T2DM patients who were 63.9% female, 86.8% White, and mean age of 57±11 yrs. Data were analyzed using paired t-tests with 53 matched patient-physician pairs. On average, T2DM patients (41.3%±29.7%) and their physicians (32.0%±30.5%) significantly overestimated 10-yr CHD risk estimates compared to the UKPDS risk engine (11.0%±12.3%), t(75)=8.27, p<.0001 and t(53)=4.5, p<.0001, respectively. Patient-physician pairs showed low rates of concordance on communication about CHD risk (14.6%) and discussions of cholesterol reduction (10.9%). Greater proportions of patient-physician pairs were discordant (40% and 25.5%, respectively) or agreed they did not discuss CHD risk (45.5%) or cholesterol reduction (63.6%). However, patient-physician pairs demonstrated higher rates of concordance on the communication about SMBG (56.4%), showing lower rates of discordance (36.4%) and agreement they did not discuss SMBG (7.3%). Concordance rates across CHD risk-related topics indicate patient-physician pairs communicate more about SMBG compared to CHD risk and cholesterol reduction. Results showed that physicians may be more effective at conveying the importance of SMBG to patients. Findings from this study suggest that both T2DM patients and physicians significantly overestimate patients’ risk for CHD. T2DM patients and physicians may both benefit from CHD risk calculations and accurate CHD information. Physicians are encouraged to follow the American Diabetes Association’s clinical practice recommendations and place greater emphasis on reducing CHD risk factors.

The authors wish to acknowledge partial funding support from NIDDK (R34DK071545) and the Ohio University, Diabetes Research Initiative.