PATIENTS' FUTURE EXPECTATIONS ABOUT DIABETES AND HYPERTENSION: THE ON TIME STUDY

Purpose:    The majority of patients with diabetes and hypertension require additional medications over time in order to maintain intensive glucose and blood pressure control. However, it is unclear whether patient expectations are closely aligned with the natural histories of these conditions. We interviewed patients to identify their future expectations for their diabetes and hypertension.

Method:   We recruited adults, aged 40-70 years old, living with co-occurring diabetes (duration <10 years) and hypertension from an academic primary care clinic (N=35). Eligibility criteria included taking oral medications for both conditions.  Patients taking insulin were excluded.  We conducted semi-structured, in-person interviews which asked subjects 3 open-ended questions about their future expectations: 1) how much longer they would need to take diabetes and hypertension medications, 2) if they expected to need additional diabetes and hypertension medications, and 3) if they believed their diabetes and hypertension could be cured. 

Result:    Subjects had a mean age of 59 years, 66% were female, and 89% were African American.  Subjects had been taking diabetes and hypertension medications for a mean of 4 and 11 years, respectively.  About half of subjects expected to stop taking their diabetes (57%) and hypertension medications (53%) within 3 years (Table).  In contrast, 14% of subjects expected to need diabetes medications and 32% expected to need hypertension medications for the rest of their lives.  About two-thirds of subjects did not expect to need additional medications for their diabetes [pills (62%) or insulin (68%)] or hypertension (69%) in the future.  An additional quarter of subjects expected to probably not need additional medications for their diabetes [pills (29%) or insulin (23%)] or hypertension (26%).  The majority of subjects believed that their diabetes could be cured (60%) or probably cured (20%).  Fewer subjects believed that their hypertension could be cured (50%) or probably cured (15%).

Conclusion:    Despite the fact that most patients with diabetes and hypertension require medications for life, we found that patients are very optimistic about the future management of their diabetes and hypertension. Most patients with co-occurring diabetes and hypertension expect to be medication-free and cured in the future.  Educating patients on the natural history of diabetes and hypertension may be an important step to managing expectations and could be used to motivate patients to enact lifestyle changes.