Physician self-reported factors driving clinical decision-making in management of patients with T2D and ASCVD/high risk of ASCVD across the Middle East and Africa: a cross-sectional study

Sam Salek^1*Hani Sabbour²Naji Alamuddin³Fatheya Alawadi⁴Hessa Alkandari^5,6Wael Almahmeed²Samir H Assaad-Khalil⁷Emel Mashaki Ceyhan⁸Jihad Haddad⁹Landman Lombard¹⁰Mary Ngome¹¹Rayaz A Malik¹²Gourav Yadav¹¹

• ¹Professor of Pharmacoepidemiology, University of Hertfordshire, Hatfield, United Kingdom
• ²Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, Abu Dhabi, United Arab Emirates
• ³Royal College of Surgeons in Ireland (Bahrain), Al Muharraq, Bahrain
• ⁴Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
• ⁵Department of Pediatrics, Farwaniya Hospital, Kuwait city, Kuwait
• ⁶Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
• ⁷Unit of Diabetes, Lipidology & Metabolism; Department of Internal Medicine/Alexandria Faculty of Medicine, Alexandria University,, Egypt, Egypt
• ⁸Novo Nordisk A/S, Søborg, Denmark
• ⁹Endocrinology Section, Bader Medical Complex, Amman, Jordan
• ¹⁰Cape Town Medical Research Centre, Cape Town, South Africa
• ¹¹Novo Nordisk Saglik Urunleri Tic Ltd Sti, Istanbul, Türkiye
• ¹²Department of Medicine, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar

Aims: To explore factors influencing the clinical decision-making of physicians treating patients with type 2 diabetes (T2D) and high risk of atherosclerotic cardiovascular disease (ASCVD) across seven Middle Eastern and African countries.Methods: Cross-sectional, anonymous online study of self-reported factors driving clinical decisionmaking for the management of T2D based on agreement with statements using a five-point Likert scale among physicians (n=385) in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and UAE between June 13 and October 1, 2022.Results: From a selection of patient factors, physicians were most likely to agree that treatment adherence/compliance (92%), safety concerns (92%), and impact on health-related quality of life (88%) influenced their decision-making. Most physicians agreed that availability of treatment (87%) was a practice setting factor that influenced their decision-making. The top three physician factors influencing clinical decision-making included continuous medical education (96%), medical knowledge (96%), and international clinical guidelines (95%). Most physicians agreed that improved communication skills of physicians (97%), coaching and question prompts for patients (91%), and patient decision aids (87%) could improve shared decision-making.Various patient, practice, and physician factors influenced physicians' management of their patients with T2D. Physicians believed improving their communication skills could improve shared decision-making.