ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Diabetes. 2018 Jun;19(4):832–839

This diabetes team are well known for, and should be applauded for, their holistic approach to diabetes care. Also, the group always points to central aspects of daily routine clinical practice and analyzes critical issues in pediatric diabetes. The aim of this study was to examine whether or not clinician qualities influence metabolic outcomes in children and adolescents with type 1 diabetes (T1D).

Data were gathered over two 3 month periods in the large tertiary diabetes center (1500 patients, 8 clinicians) in the state of Victoria, Australia, from patients with T1D who received continuous care from each individual clinician. Clinician factors explored included target blood glucose levels, target glycated hemoglobin (HbA1c), Diabetes Attitude Scale and Big 5 Personality Inventory Scale. Mean HbA1c per clinician was the primary outcome variable.

Lowest to highest mean HbA1c per clinician varied by only 0.7%. There were small but statistically significant differences between clinicians with their patients’ age at diagnosis, duration of diabetes, age, gender, treatment type and BMI SD score. After controlling for these differences, the clinician characteristics associated with lower mean HbA1c were having no lower limit in target HbA1c and being self-reportedly “less agreeable”. Importantly, the impact of these clinician attitudinal traits was equivalent to the combined effects of patient characteristics and treatment type.

There was significant variation in metabolic outcomes between treating clinicians. After controlling for patient clinical differences, clinician mean HbA1c was associated with lower limit in target HbA1c and being “less agreeable.” Clinicians who were more demanding and dogmatic appeared to have better outcomes.

These data are a worry some for those of us physicians who feel that a more democratic and liberal attitude might achieve better patient adherence and metabolic control. However, the personality analysis performed here might not give a complete picture of the physician’s attitudes and whether or not the physician is liked and trusted. Other limitations are the number of physicians (8) and their possible confounders, such as age and gender.