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It's a complex mental process that your doctors go through when they choose your medicines, according to a recent survey of several hundred physicians.
It's based less on hard numbers than on hazier subjective considerations, and there are differences in the way that general practitioners think compared to diabetes specialists.
Both generalists and specialists report that at each of the three main stages of medication management (initiating first meds, beginning second-line oral agents, and starting insulin), they consider your overall health, your A1c, and your "adherence behavior," but not so much your age or written treatment guidelines.
When it comes to prescribing insulin, more generalists than specialists consider patient adherence: 76 percent versus 60 percent. When deciding whether to begin insulin, 68 percent of generalists identify patient fear of injections and patients' desire to stay off insulin as major barriers.
Overall, qualitative factors such as adherence, motivation, and overall health are given somewhat more weight than quantitative factors such as age, A1c, and weight. The decision-making process is definitely less straightforward than "evidence-based treatment guidelines," would make it seem; such guidelines aim to dictate the decision process based solely upon hard scientific evidence.
Source: Diabetes Care, June 2007
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