Research Investigates Educational Level and Diabetes Treatment Preferences

Man sitting on couch, testing blood glucose with monitor

Recently published research at MedStar investigated the link between the educational level of study participants and treatment preferences for type 2 diabetes medication. This stratification study sought to clarify treatment preferences for participants with type 2 diabetes based on their educational level: completed high school or less, completed some college, or completed college or more education.

This study was a collaborative between Joan K. Bardsley, MBA, RN, COE, FAADE, of MedStar Health Research Institute and MedStar Nursing, with colleagues at Virginia Commonwealth University and Johns Hopkins Bloomberg School of Public Health.

Diabetes is a chronic disease that affects 29.1 million people (9.3%) and is the seventh leading cause of death in the US. Research has shown that people with lower income and less education are two to four times more likely to develop diabetes and more likely to be affected by complications of diabetes.

Treatment preferences for different aspects of diabetes medication were measured using a discrete-choice experiment (DCE). In a DCE, it is assumed that a treatment profile (in this case diabetes medication) is defined by a variety of characteristics, or attributes that can exist at different levels. Participants were asked to complete several choice tasks in which they are presented with one or more distinct treatment profiles, comparing pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost.

In this study, a DCE was used to show that persons with type 2 diabetes do not only value reductions in their A1c levels but also had preferences for medications that stabilized their daily glucose levels and that reduced burden/harms of medication.

Those with a higher education were willing to pay more for all medication attributes than those with lower educational attainment, possibly due to their higher average income. Participants with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day.

The findings in this study also suggest that people with diabetes patients with lower levels of education are willing to allocate more of their budget to avoid a higher treatment burden and that they might place more value on keeping their glucose levels within a daily target range.

“Being aware of patient preferences and that these preferences might vary by demographic characteristics can help clinicians tailor treatment approaches to patients by either adapting treatment or increasing educational efforts on the importance of lowering A1c,” the study concluded.

Dove Press, 2017. DOI: 10.2147/PPA.S139471