What Were They Thinking? How Doctors Choose Your Type 2 Medicine

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It's a complex mental process that your doctors go through when theychoose your medicines, according to a recent survey of severalhundred physicians.

It's based less on hard numbers than on haziersubjective considerations, and there are differences in the way thatgeneral practitioners think compared to diabetes specialists.

Both generalists and specialists report that at each of the threemain stages of medication management (initiating first meds,beginning second-line oral agents, and starting insulin), theyconsider your overall health, your A1c, and your "adherencebehavior," but not so much your age or written treatment guidelines.

When it comes to prescribing insulin, more generalists thanspecialists consider patient adherence: 76 percent versus 60percent. When deciding whether to begin insulin, 68 percent ofgeneralists identify patient fear of injections and patients' desireto stay off insulin as major barriers.

Overall, qualitative factors such as adherence, motivation, andoverall health are given somewhat more weight than quantitativefactors such as age, A1c, and weight. The decision-making process isdefinitely less straightforward than "evidence-based treatmentguidelines," would make it seem; such guidelines aim to dictate thedecision process based solely upon hard scientific evidence.

Source: Diabetes Care, June 2007

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