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Intensification to injectable therapy in type 2 diabetes: mixed methods study (protocol).

Simon de Lusignan1,2, William Hinton3, Emmanouela Konstantara3

  • 1Department of Clinical and Experimental Medicine, University of Surrey, The Leggett Building, Daphne Jackson Rd, Guildford, GU2 7XP, UK. s.lusignan@surrey.ac.uk.

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Summary
This summary is machine-generated.

Understanding patient and clinician views on initiating injectable therapy for type 2 diabetes (T2D) is crucial. This research explores decision-making in primary care to improve treatment intensification and glycaemic control for T2D management.

Keywords:
Diabetes mellitus, type 2Electronic health recordsFocus groupsGeneral practiceGlucagon-like peptide-1 receptorInsulinMedical record systems, computerizedPatientsQualitative researchSurveys and questionnaires

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Area of Science:

  • Endocrinology and Metabolic Diseases
  • Primary Care Medicine
  • Health Services Research

Background:

  • Type 2 diabetes mellitus (T2D) management in the UK primarily occurs in primary care.
  • Delayed intensification to injectable therapy, a form of clinical inertia, is linked to poorer glycaemic control.
  • Computerised medical records allow quantitative analysis but not insight into decision-making processes.

Purpose of the Study:

  • To investigate primary care patients' and clinicians' perceptions regarding the initiation of injectable therapies for T2D.
  • To explore the contextual factors influencing decisions about injectable therapy initiation in T2D management.

Main Methods:

  • Mixed-methods study employing a realist evaluation approach.
  • Qualitative components: focus groups, interviews, and simulated surgery video recordings.
  • Quantitative components: practice overviews, video analysis, and an online clinician survey.
  • Recruitment of T2D patients and primary care clinicians from the RCGP Research and Surveillance Centre network.
  • Analysis includes Framework Analysis for qualitative data and summary statistics for survey data.
  • Simulated consultations assessed using the Calgary-Cambridge model for communication and guideline adherence.
  • Multi-channel video recording captures consultations, including screen activity and non-verbal cues.

Main Results:

  • The study aims to offer a detailed insight into the complex decision-making process for initiating injectable therapy in T2D.
  • Findings will illuminate the dynamics between patients and clinicians in this critical treatment decision.

Conclusions:

  • The research will provide valuable insights into current clinical practices for T2D injectable therapy initiation.
  • Results will inform the development of targeted training, interventions, and guidelines to optimize treatment intensification.
  • Facilitating appropriate intensification can lead to improved glycaemic control and patient outcomes in T2D.