Men, Smokers with Diabetes Meet with Health-care Providers Less Often

Men and smokers with Type 2 diabetes meet with health-care providers at diabetes management centres less often to monitor their illness, according to a new study.

Attrition rates for diabetes self-management programs are high,” says lead author and Assistant Professor Enza Gucciardi, Ryerson University’s School of Nutrition, “despite potentially serious complications such as cardiovascular disease, amputation, or blindness if people with diabetes leave their condition unmanaged.” More than two million Canadians live with diabetes.

Gucciardi found that men were 21 per cent less likely than women to return to see their health-care providers at the diabetes education centres, and that smokers were 34 per cent less likely than non-smokers to use diabetes education services. The study’s co-authors were Margaret DeMelo of Toronto Western Hospital, Gillian Booth, George Tomlinson and Donna Stewart of University of Toronto.

The researchers also discovered that patients who were either unemployed, had a lower body-mass index, lived closer to a centre, or had a longer history of diabetes stayed in contact more regularly with their health professionals.

They studied 260 patients with Type 2 diabetes who attended one of two diabetes management centres in Toronto for at least one year after their initial visit.

The researchers examined patients’ personal characteristics, such as age, sex, education, marital status, social supports, smoking habits, nutrition self-care, body-mass index, number of symptoms and years living with diabetes. They also examined wait times for an initial appointment, patients’ source of referral, and whether or not their physicians encouraged use of a diabetes management centre.

“Diabetes self-management programs don’t fit the ‘if-you-build-it-they-will-come’ model,” says Gucciardi, who is also an affiliate scientist at the University Health Network Women's Health Program and the Toronto General Hospital Research Institute.

“The question is: how do we provide useful services so patients will come back?”

At the two diabetes management centres, the researchers found that follow-up use of their services varied significantly. Patients followed up more often with their health-care providers at the location that offered flexible service hours and a variety of optional educational courses. Health professionals from that site also sent orientation packages to patients before their first visit. They also distributed to patients newsletters containing healthy recipes, details about upcoming workshops and events, and information on new drugs and self-management issues.

Although further research is needed, says Gucciardi, she believes these supportive forms of communication may increase patients’ retention in diabetes self-management programs.

“Knowing the factors that affect a patient’s decision to attend follow-up visits is important,” says Gucciardi. “We need diabetes management centres that are flexible and can cater to people’s unique needs.”