Does remission of type 2 diabetes matter? A qualitative study of healthcare professionals' perspectives and views about supporting remission in primary care

Abstract

Background: Trials conducted in highly selected populations have shown that type 2 diabetes (T2D) remission is possible, but the feasibility and acceptability of supporting remission in routine clinical practice remain uncertain. Aim: We explored primary care professionals' perceptions and understandings of T2D remission and their views about supporting remission within routine clinical care. Methods: Semi-structured interviews were conducted with 14 GPs and nine nurses working in Scottish general practices. Data were analysed thematically. Results: Most participants considered remission to be a motivational tool but were unsure that it actually altered clinical management, due to patients still requiring follow-up and their expectations that remission is often temporary because of the constant effort required to sustain remission in an obesogenic environment. These perceptions, together with participants' concerns about loss to follow-up of patients who were likely to relapse and/or were still at high cardiovascular risk, appeared to underpin a reluctance to code remission in medical records. Most participants did not consider remission support to be a clinical priority. Moreover, they described being sensitive to the pitfalls of only encouraging some patients to pursue remission, because if resources were directed towards apparently more motivated, affluent individuals, there was a risk that this could widen health inequalities. Conclusion: For integration of remission support into mainstream T2D care to be successful, primary care professionals may need to be persuaded that remission matters more than encouraging well-managed T2D. They would also benefit from clear guidance on follow-up and optimal support for people in remission.