HOW INFORMATION ON TIMING OF GLUCOSE AND BLOOD PRESSURE CONTROL AFFECTS PATIENT DECISION-MAKING IN DIABETES: THE ON-TIME STUDY

Purpose: �� Major diabetes trials show that the timing of glucose and blood pressure control has important effects on patient outcomes. �Intensive glucose control lowers complication rates only after 10 years of therapy (lag time), and these benefits last an additional 10 years after glucose levels are no longer well-controlled (duration of benefit).� Conversely, intensive blood pressure control lowers complication rates after 3 years, and these benefits persist only while blood pressure is well-controlled. We examined whether providing patients with lag time and duration of benefit information affects their likelihood of starting additional medications for glucose and blood pressure control.

Method: �� We recruited adults, aged 40-70 years old, living with co-occurring diabetes (duration <10 years) and hypertension from a primary care practice (n=35).� We conducted semi-structured, in-person interviews. �We presented subjects with 2 hypothetical scenarios in random order, in which they were recommended additional medications by their physicians for glucose and blood pressure control.� Subjects were asked their baseline likelihood of starting an additional medication on a scale of 1 (not at all) to 10 (very), and then they were provided information on lag time and duration of benefit.� Subjects were asked whether their likelihood of starting medications increased, decreased or stayed the same with additional information.�

Result: �� Mean age was 59 years, 66% were female, and 89% were African American. �For both glucose and blood pressure control, 60% of patients were very likely (score ≥7) to start an additional medication. When presented with lag time information for intensive glucose control, almost half of subjects reported a decreased likelihood of starting additional medications (46%, n=16).� However, when presented with duration of benefit information, nearly half reported an increased likelihood of starting additional medication (43%, n=15).� In contrast, for blood pressure control, similar proportions reported increased and decreased likelihood for both lag time and duration of benefit information (Table).�

Conclusion: �� Differences in lag time and duration of benefit for glucose and blood pressure control in diabetes may have important effects on patient decision-making.� The shorter lag time and duration of benefit of intensive blood pressure control may have small effects on patient decision making.� However, the longer duration of benefit from intensive glucose control may be a strong motivator for patients to start additional diabetes medications. �