IDF21-0509 Concerns about cardiovascular complications among type 2 diabetes mellitus patients: a qualitative approach

Background: Cardiovascular (CV) disease is the leading cause of death and morbidity in individuals living with type 2 diabetes mellitus (T2DM). T2DM is associated with a higher risk to develop CV disease. However, identifying factors representing a significant concern for individuals living with T2DM remains to be investigated. Understanding people's concerns and the impacts of diabetes on various aspects of life is critical to meet individual healthcare needs and develop a patient centric approach. The CONCORDIA study evaluates individuals living with T2DM main concerns, impacts on their lives, and factors individuals most value in their health care, confronting them with the perspective of the health care professionals (HCPs). Aim: In this CONCORDIA sub-analysis we have identified main concerns related to cardiovascular complications of Diabetes and compared perspectives between individuals living with T2DM, in different stages of disease, and HCPs. Method: Five focus groups were conducted: two with HCPs (physicians and nurses) and three with individuals living with T2DM in different stages of disease, using a semi-structured format. The study was implemented at Portuguese Diabetes Association (APDP), and an intentional sampling was used to maximize the differences within participants' characteristics. Individuals living with T2DM were grouped according th the following criteria: G1-diagnosed at least 12 months ago without complications; G2-diagnosed at least 12 months ago with minor complications (CKD stage 3a and R1 retinograms) or G3- with major complications (patients followed by a nephrologist and/or undergoing laser treatments and/or intravitreal injections in Ophthalmology). Data were transcribed and analyzed using thematic analysis. Results: Forty-seven items of concerns were identified and grouped into fourteen themes. Twelve items of concerns were identified within “complications” theme, three of them specifically related to CV complications - blood pressure, stroke, and heart problems. Stroke and heart attacks were only mentioned by HCPs. Regarding individuals living with T2DM, CV and blood pressure concerns were only identified in the “complications” theme. Despite being a risk factor for CV disease, in this analysis blood pressure was considered a concern. Blood pressure was only mentioned by the group of individuals with T2DM with major complications. Moreover, individuals living with T2DM refer heart problems in an unspecific way, showing relative difficulty in differentiating risk factors from actual CV disease. Discussion: The results revealed that concerns related to CV complications, such as heart problems, blood pressure, and stroke, were not the most mentioned and when verbalized were done so in a general and unspecific way by individuals living with T2DM. This data is the first step in the development of a questionnaire that aims to assess concerns, compare perspectives, and analyze differences in two different scopes of a complex disease like T2DM. In conclusion, even if CV disease is the first cause of death among individuals living with T2DM, it is rarely referred as a concern in this population. It is extremely important to understand if this lack of awareness could be a problem of communication among stakeholders increased by a low health literacy level, within the scope of T2DM’s complex picture.