Difficult conversations: adults with diabetes and the discussion of microvascular complications

To investigate the experiences among adults with diabetes of discussions of microvascular complications and provide recommendations for providers.

We performed a qualitative study in 148 adults with Type 1 and Type 2 diabetes (56% women, 95% white, mean age 60±13 years, 65% with Type 1 diabetes, 71% with ≥1 microvascular complication). Data were analysed using content analysis.

At their first discussion of microvascular complications, 93% of participants (138/148) recalled providers using a preventative approach including clinical suggestions, factual information and warnings. At complication diagnosis, 78% of participants (82/105) perceived provider support through comprehensive interactive education, specific self-care guidance, reassuring messages, and referrals and follow-ups. In response to complication diagnosis, 48% (50/105) felt scared, 46% (48/105) had 'a wake-up call', and 86% (90/105) reported increasing ≥1 specific area of self-care. Participants recommended providers offer factual and complete information, specific self-care guidance, and positive honesty, with an individualized and collaborative approach that includes psychosocial assessment and referrals and lacks 'scare tactics' and blame.

Adults with diabetes want to learn about diabetes microvascular complications and apply preventative strategies as early as possible. Paradoxically, the diagnosis of a diabetes microvascular complication in itself may represent a unique learning opportunity because 86% of participants improved diabetes self-care after this event. Recommendations offer providers simple but important clinical approaches to improve these difficult conversations and thus support necessary behaviour changes and psychosocial well-being. Training is needed to help providers discuss the threat of diabetes complications with honest but positive messages so that people with diabetes can be fully informed but also maintain hope in the face of complications.