Diabetes and Diabetic Nursing Care

Evidence-based approaches to the care of patients with type 2 diabetes (T2D) are based largely on clinical trials and routinely bypass practical impediments such as patient preferences, awareness, and motivational barriers. Although uncovering factors that infl uence adherence in T2D patients is well explored in the literature, the systematic overlap of quantitative electronic health record (EHR) and payer data with qualitative data is lacking. We conducted a prospective mixed-method study of 500 patients with varying levels of glycemic control and oral antidiabetic adherence, identified through EHR and payer information. We developed a conceptual model using two online methods overlaid with EHR and prescription claims information. Qualitative insights were collected using two online methods: daily snapshots over a 12-day period that included anecdotes, uploaded pictures, videos and comments about daily postings; and an online panel where patients shared their own views on T2D and adherence and commented on views from other patients. We consented 44 patients with 23 completing the study. Built around adherence measures as the

fi rst tier of segmentation and considering glycemic control, disease and attitudinal orientation, the model partitions patients into 8 distinct segments each portraying unique phenotypic characteristics. Although preliminary, these groupings may assist providers, healthcare systems and payers identify patient types and incorporate more eff ective ways of engaging specific patient groups, thus facilitating greater adherence, better illness management and more robust treatment outcomes.