Minimally Disruptive Medicine for Patients with Diabetes
Purpose of review
Patients with diabetes must deal with the burden of symptoms and complications (burden of illness). Simultaneously, diabetes care demands practical and emotional work from patients and their families, work to access and use healthcare and to enact self-care (burden of treatment). Patient work must compete with the demands of family, job, and community life. Overwhelmed patients may not have the capacity to access care or enact self-care and will thus experience suboptimal diabetes outcomes.
Minimally disruptive medicine (MDM) is a patient-centered approach to healthcare that prioritizes patients’ goals for life and health while minimizing the healthcare disruption on patients’ lives.
In patients with diabetes, particularly in those with complex lives and multimorbidity, MDM coordinates healthcare and community responses to improve outcomes, reduce treatment burden, and enable patients to pursue their life’s hopes and dreams.
KeywordsMinimally disruptive medicine Patient-centered care Burden of treatment Patient capacity Diabetes
We would like to thank Ian Hargraves for his collaboration with the figure of this manuscript. The authors are part of the International Minimally Disruptive Medicine Research Group (http://minimallydisruptivemedicine.org).
VS and VMM served as overall principal investigators, conducted the literature review, and wrote and reviewed the manuscript. GSB and KB helped with the literature reviewed, revised the manuscript, and assisted with adaptations. All authors read and approved the final manuscript. VMM is the guarantor of this work.
GSB was supported by CTSA Grant Number TL1TR000137 from the National Center for Advancing Translational Science (NCATS) and Grant Number 3R01HL131535-01S1 from the National Heart Lung and Blood Institute (NHLBI). VMM and KRB were partially supported by Grant Number UL1TR000135 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the author and do not necessarily represent the official view of the NIH. The content of this work is solely the responsibility of the authors and does not necessarily represent the official opinion of NIH.
Compliance with Ethical Standards
Conflict of Interest
Valentina Serrano, Gabriela Spencer-Bonilla, Kasey R. Boehmer, and Victor M. Montori declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.WHO: Global Report on Diabetes. World Health Organization. 2016.Google Scholar
- 6.• Tran V-T, Barnes C, Montori VM, Falissard B, Ravaud P. Taxonomy of the burden of treatment: a multi-country web-based qualitative study of patients with chronic conditions. BMC Med. 2015;13:115. This article describes the taxonomy of burden of treatment, based on surveys applied to more than 1000 patients with chronic conditions CrossRefPubMedPubMedCentralGoogle Scholar
- 8.•• May CR, Eton DT, Boehmer K, Gallacher K, Hunt K, MacDonald S, et al. Rethinking the patient: using burden of treatment theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014;14:281. This manuscript helps us understand the work of being a patient with multi-morbidity and the resources necessary to respond to the demands of illness and treatments CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Duke KS, Raube K, Lipton HL. Patient-assistance programs: assessment of and use by safety-net clinics. Am J Health Syst Pharm. 2005;62Google Scholar
- 17.Wharam JF, Zhang F, Eggleston EM, Lu CY, Soumerai S, Ross-Degnan D: Diabetes outpatient care and acute complications before and after high-deductible insurance enrollment: a Natural Experiment for Translation in Diabetes (NEXT-D) study. JAMA Internal Medicine 2017.Google Scholar
- 18.•• Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol. 2012;65:1041–51. This article introduces the Cumulative Complexity Model, a functional and patient-centered model of patient complexity that contributes to formulate Minimally Disruptive Medicine interventions CrossRefPubMedGoogle Scholar
- 21.•• May C, Montori VM, Mair FS: We need minimally disruptive medicine. BMJ: British Medical Journal (Online) 2009, 339. This was the first publication in which the term “Minimally disruptive Medicine” was coined, highlighting why the way we take care of patients can cause disruption and suffering and why we must seek an alternative. Google Scholar
- 22.• Eton DT, Yost KJ, Lai J-S, Ridgeway JL, Egginton JS, Rosedahl JK, Linzer M, Boehm DH, Thakur A, Poplau S: Development and validation of the Patient Experience with Treatment and Self-Management (PETS): a patient-reported measure of treatment burden. Quality of Life Research 2016:1–15. This paper presents the development and validation of a new instrument to measure burden of treatment in patients with multitimorbidity. Google Scholar
- 29.Spencer-Bonilla G, Quiñones AR; Montori VM: Assessing the burden of treatment. Submitted for publication.Google Scholar
- 31.Leppin AL, Montori VM, Gionfriddo MR: Minimally disruptive medicine: a pragmatically comprehensive model for delivering care to patients with multiple chronic conditions. In: Healthcare: 2015: Multidisciplinary Digital Publishing Institute; 2015: 50–63.Google Scholar
- 36.Hoogma R, Hammond P, Gomis R, Kerr D, Bruttomesso D, Bouter K, et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med. 2006;23:141–7.CrossRefPubMedGoogle Scholar
- 37.• Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58:429–42. This is the ADA and EASD Position Statement about management of type 2 diabetes patients, which mentions for the first time the importance of a patient-centered approach CrossRefPubMedGoogle Scholar
- 43.KER Unit. Mayo Clinic. The Instrument for Patient Capacity Assessment (ICAN) [https://minimallydisruptivemedicine.org/ICAN/. Accessed 29 March 2017].
- 44.KER Unit. Mayo Clinic. My Life, My Healthcare—ICAN and Statin Choice used in single visit [https://www.youtube.com/watch?v=a0H9RRGIFJg&feature=youtu.be. Accessed 29 March 2017.]
- 47.Patient Education Research Center. Stanford University. Chronic disease self-management program [http://patienteducation.stanford.edu/programs/cdsmp.html. Accessed 29 March 2017].
- 48.WellConnect Program. SE MN Partnership [https://www.wellconnectsemn.org/. Accessed 29 March 2017.]
- 52.Boehmer K. What is capacity coaching? Minimally Disruptive Medicine Blog. 2016 [https://minimallydisruptivemedicine.org/2016/02/02/what-is-capacity-coaching-and-a-new-pilot-initiative-where-they-are-trying-it-out/. Accessed 29 March 2017.]
- 56.Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996:511–44.Google Scholar
- 57.Boehmer KRD, Gionfriddo, MR Erwin P, Montori, VM: Minimally disruptive medicine model of care versus the chronic care model: a systematic review and thematic synthesis. Submitted to publication.Google Scholar