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Outcomes/Effectivness Research

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Training clinicians to support the autonomy of patients with diabetes may help improve outcomes

Getting patients with diabetes to manage the disease with diet, exercise, blood sugar measurements, and medication compliance is a huge challenge for doctors. According to a study supported by the Agency for Healthcare Research and Quality (HS10123), when doctors encourage patients to become actively involved in managing their diabetes and persuade them that they are competent to do so, the patients tend to be less depressed, more satisfied, and have lower blood sugar levels.

The researchers surveyed 634 patients with type 2 diabetes being cared for by 31 Colorado primary care physicians (PCPs) who were participating in a 4-year diabetes quality improvement program. Researchers collected information on demographics, disease and treatment, and autonomy support. Autonomy support included how supportive their PCP was of patients managing their diabetes by providing them with information, choices, and options for handling their diabetes and respecting the patients' perspectives. Researchers also measured patient satisfaction, depressive symptoms, and perceived competence. The patients' blood glucose (HbA1c) levels were measured to check the average level of glycemic control they had maintained over the previous 3 to 4 months.

Autonomy support was positively associated with perceived competence and patient satisfaction and negatively associated with depression and HbA1c levels. Thus, clinician support of a patient's management of their own diabetes had a significant direct effect on patients' perceived competence and satisfaction and significant indirect effects on depression and HbA1c levels.

See "Variation in perceived competence, glycemic control, and patient satisfaction: Relationship to autonomy support from physicians," by Geoffrey C. Williams, M.D., Ph.D., Holly A. McGregor, M.S., Diane King, M.S., O.T.R., and others, in the April 2005 Patient Education and Counseling 57, pp. 39-45.

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