Clinicians face hurdles in effectively communicating cardiovascular risk to diabetes patients

A Swedish study reveals healthcare professionals struggle to convey the heart-related dangers of type 2 diabetes, hindered by time constraints, organisational challenges, and emotional tolls, prompting calls for ongoing, personalised risk dialogues.

A study from northern Sweden has found that many clinicians know people with type 2 diabetes face a sharply higher risk of cardiovascular disease, but still struggle to make that danger clear in everyday care. Published in Nursing Open, the research suggests that the problem is not simply a lack of information. Instead, it is a mix of time pressure, fragmented teams, uncertainty over how to assess risk and the difficulty of turning medical numbers into something patients can use in their own lives.

The study drew on interviews with 14 primary care professionals, including diabetes specialist nurses and physicians working in urban and rural settings. Using a grounded theory approach, the researchers examined how clinicians judge risk, explain it and respond to patients’ reactions. Their central finding was that staff were trying to improve awareness of heart danger while constantly balancing responsibility against doubt, according to the paper indexed in PubMed and summarised by Life Science.

Clinicians described checking HbA1c, blood pressure, cholesterol and lifestyle factors, but many said it was hard to know which measure best captured a person’s real cardiovascular risk. Some leaned heavily on glucose control, while others prioritised lipids first. The paper says many relied on visual tools from the Swedish national diabetes register, and some physicians used structured scoring systems such as SCORE2, but several staff still avoided formal risk assessment because the process was seen as cumbersome and time-consuming. Earlier reviews have long argued that personalised risk information only helps when it is understandable, engaging and tied to behaviour change, and this new study suggests those conditions are still often missing in practice.

The communication challenge went well beyond technical assessment. Participants said they tried to gauge what each patient already understood, then used plain language, visual explanations and repeated checks for comprehension. Some framed the risk of stroke, heart attack, kidney disease and vision loss, but the researchers found that staff were sometimes more comfortable discussing microvascular complications than the heart and vessel risks linked to diabetes. That hesitation matters, because studies cited in the broader literature have repeatedly shown that cardiovascular risk is difficult to convey in a way that patients remember and act on.

What made the findings particularly striking was the emotional toll on staff. Clinicians spoke of frustration, self-doubt and the pressure to encourage change without shaming people who were already overwhelmed, fearful or struggling with mental health problems. Trust and continuity emerged as essential: professionals said it was easier to have meaningful conversations when they knew patients well and saw them repeatedly. But the system often worked against that ideal. Appointments were limited, follow-up was thin and some patients were seen only once a year, despite guidance calling for more frequent review. Nurses also described carrying too much responsibility in the absence of reliable physician support, while some said they did not always agree with the decisions being made around them.

The authors argue that cardiovascular risk communication in diabetes should be understood as an ongoing dialogue rather than a one-off transfer of facts. Their conclusion is that calculators and charts alone are not enough: patients need consistent messages, time for questions and care teams that speak with one voice. The study’s limitations include a small sample, recruitment through snowball and convenience methods, a largely female participant group and the possibility that remote interviewing affected rapport. Even so, the findings align with a wider body of research showing that clear communication, organisational backing and personalised explanation are central to reducing cardiovascular risk in type 2 diabetes.