Beneath the surface: discovering the unvoiced concerns of older adults with Type 2 diabetes mellitus

Emerging clinical guidelines recommend shared decision making to individualize drug regimens for older adults with Type 2 diabetes mellitus. While the current health education campaign for diabetes in the United States recommends physician-initiated medication-related discussions about adherence and side effects, little emphasis is placed on soliciting patient concerns. This study’s aim was to ex-plore the concerns of older adults with diabetes about the complexity of their drug regimens and to determine whether they discussed medication-related concerns with their physician. Twenty-two patients with Type 2 diabetes age 65 years and older who used five or more medications were selected from an urban academic geriatric medi-cine practice in the United States. In-depth semi-structured interviews were conducted to uncover participants perceptions of multiple medication use and related discussions with providers. The predominant theme that emerged was the vari-ability in medication-related topics that patients perceived they could discuss with their physician. While most participants described physician-initiated discussions about adherence and side effects, many did not bring up concerns about medication cost or their desire to reduce medica-tion burden. In order to encourage greater patient involvement in medication decision making for diabetes treatment, educational messages pro-moting patient–physician dialogue need to take more account of patient concerns