Background. Patient-physician communication is an important part of diabetes care that may influence the outcomes. Better understanding of the problems of an individual patient could help to develop his/hers higher motivation for the effective self-management. Patient’s and physician’s views on the patient’s problems may be culture- and country-specific.
Aim. To identify the most challenging issues in diabetes management and living with diabetes from the point of view of patients compared to that of physicians. 
Methods. The study was conducted as a survey in patient and physician cohorts in three regions of Russia. 180 randomly selected doctors participated, 101 of them being endocrinologists and 79 internists (two specialties involved in diabetes care in this country). In general, the doctors had been in practice for 0,5 to 45 years. Endocrinologists were seeing on average, 150 type 2 patients monthly and internists, on average, 15 patients. The patient sample included 320 consecutively recruited type 2 diabetic patients (F/M=239/81, aged 40 to 84 years, with duration of diabetes 0,5 - 36 years and HbA1c level of 5,3 to 14,7% (mean ± SD 9.1±1.8%). The doctors and the patients were administered an identical list of various aspects of diabetes management/living with diabetes and asked to choose 3 of them which they believed to be most challenging for patients. Differences in proportions were tested with 2 or Fischer’s exact test. For any correlations between doctors and patients opinions, the Pearson’s correlation coefficient was calculated. Results were considered significant at alfa level < 0,05.
Results. The results are given in the Table. 
Items	Patients (n=320)	Doctors (n=180)	P value
	%	rank	%	rank	
Causes / mechanisms of diabetes	50,2	2	4,6	11	<0,001
Diet	29,6	3	43,1	1	0,003
Blood glucose self-monitoring	20,9	5	29,3	5	0,043
Insulin therapy	11,3	8	33,9	4	<0,001
Oral therapy	2.0	14	0	-	0,09
Late complications	52,2	1	42,0	2	0,041
Physical exercise	10,0	9	2,9	12	0,002
Hypoglycemia	5,0	10	9,8	9-10	0,052
Ketoacidosis	17,6	6	9,8	9-10	0,033
Concomitant / intercurrent diseases	25,3	4	14,4	8	0,006
Social issues	3,0	13	23,6	6	<0,001
Psychological issues	3,7	11	21,8	7	<0,001
Financial issues	14,9	7	38,5	3	<0,001
None of the listed	3,3	12	0	-	0,009 

From the patients’ perspective, the three most challenging issues for the patients were: late complications, causes and mechanisms of diabetes, and diet. From the doctors’ perspective, the patients are mostly challenged by diet, late complications and financial issues of living with diabetes. In fact, all problems of diabetes management that the patients could meet with, except oral therapy and hypoglycemia, were differently rated by the doctors and by the patients. No correlation between rankings made by the patients and the doctors was found. No major differences between choices made by the endocrinologists and by the internists were observed, except the following: endocrinologists rated the patient psychological problems as more important than internists did (33.0% and 15.5%, respectively, р=0.011); the same was true for diabetes-related financial problems (57.4% and 31.0%, р<0.001). The opinion of the doctors was unrelated to their working experience. There were no differences in the choices between insulin-treated (n=84) and non-insulin treated (n=236) type 2 diabetic patients, with their rankings of the problems being highly correlated (Spearman’s r=0.96, р<0.00001). No associations between the choices of patients and their glucose control were found.
Discussion and conclusion. There is a dramatic discordancy in the views of doctors and patients on the most challenging and problematic aspects of living with diabetes and diabetes management. This difference was unrelated to the doctors’ length of experience with diabetes care, and was almost unrelated to their specialty (endocrinologist or internist). The major limitation of our study was that the survey in doctors and patients was conducted in different clinics, so we were unable to link the results with the quality of diabetes care provided by the doctors in their patients. However, the results obtained demonstrate a lack of a major pre-requisite for effective diabetes management, i.e. an agreement between a doctor and a patient on the most important problems that is necessary to make patients motivated and actively participating in their self-management.

Problems and challenges of type 2 diabetes management from the doctors and patients perspectives: a survey