Patient-reported outcome measures in the management of type 2 diabetes in primary care setting

Abstract

Living with Type 2 diabetes mellitus (T2DM) can be stressful and cause emotional and psychological impact on patients such as depression that can impede their quality of life. However, the use of valid Patient-Reported Outcome Measures (PROMs) can be used to elicit emerging patient needs throughout their management and be used by healthcare professionals to tailor treatment plans for individual patients. Given the majority of T2DM care is delivered via primary care services, this review will identify PROMs relevant for patients in this setting and determine the quality of each PROM in terms of the methodological rigor of its development and validation. The author searched Embase, MEDLINE, PsycINFO, CINAHL, Scopus, Web of Science, and Cochrane reviews and trials for both observational and interventional studies that used a PROM with patients with T2DM. COnsensus based Standard for Selection of Health Measurement Instrument guidelines (COSMIN) were used for assessing the development and validation processes for each instrument. Ninety six studies that included 45 PROMs were identified and included four validation studies for four PROM instruments. The majority of PROMs were diabetes specific (35.5%), 11 (24%) depression and anxiety related, 10 (22%) were general, five (11%) medication adherence related, two (4%) aimed to assess chronic diseases impact, and one instrument was stroke-related. The Patient Health Questionnaire (PHQ-9) was used the most in 28 studies. All identified PROMs methodological were judged to be low or very low in quality against the COSMIN guidelines. In order to support efforts to improve outcomes for patients with T2DM, further work is needed to develop PROM instruments for this target patient population and context using methodologically rigorous, gold standard approaches. Based on the current evidence, identified PROMs should undergo further validation processes to support credible assessments of patient-reported outcomes relevant for T2DM in primary care.