{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:12:26Z","timestamp":1781532746526,"version":"3.54.5"},"reference-count":16,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UM1TR004406"],"award-info":[{"award-number":["UM1TR004406"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIA","award":["K01-AG084971"],"award-info":[{"award-number":["K01-AG084971"]}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Online patient portal messaging may accelerate access to endocrinology care providers for people with diabetes; however, the ways in which older adults use portal messaging as part of their care have not been well characterized. This study aimed to explore the needs, concerns, and health care behaviors expressed in patient-initiated portal messages sent by older adults with type 2 diabetes (T2D) to their endocrinology providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We conducted a hybrid deductive and inductive thematic analysis of patient-initiated portal messages from adults aged 65 years or older with T2D receiving diabetes care at the hospital-based outpatient endocrinology clinic. We included all older adults who had one or more visits with a provider in 2023. We analyzed the content from the first message of each thread. Linked electronic health record data were used to characterize the sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 882 older adults living with T2D receiving outpatient endocrinology care, 427 (48.4%) sent one or more patient portal messages (mean age 71.8 years; 54% women; 72% White). We identified eight themes in portal messages, including 1) barriers to accessing medications, 2) barriers to accessing glucose monitoring supplies, 3) medication questions, 4) unaffordability of care, 5) requests to interpret laboratory or diagnostic results, 6) transmission of glucose monitoring data, 7) nutrition or supplement questions, and 8) general nonurgent medical questions, with corresponding subthemes detailing issues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The content of patient-initiated portal messages sent by older adults to their endocrinologists included varied topics, with a large portion comprising administrative requests and challenges accessing medications and supplies rather than clinical questions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>","DOI":"10.2337\/doc25-0079","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:34:12Z","timestamp":1776098052000},"page":"374-384","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Qualitative Analysis of Patient Portal Messages From Older Adults With Type 2 Diabetes"],"prefix":"10.2337","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2701-101X","authenticated-orcid":false,"given":"Anna R.","family":"Kahkoska","sequence":"first","affiliation":[{"name":"Department of Nutrition, The University of North Carolina at Chapel Hill 1 , Chapel Hill, NC"},{"name":"Division of Endocrinology and Metabolism, School of Medicine, The University of North Carolina at Chapel Hill 2 , Chapel Hill, NC"},{"name":"Center for Aging and Health, The University of North Carolina at Chapel Hill 3 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey J.","family":"Kelley","sequence":"additional","affiliation":[{"name":"Center for Aging and Health, The University of North Carolina at Chapel Hill 3 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Lourduraj","sequence":"additional","affiliation":[{"name":"Center for Aging and Health, The University of North Carolina at Chapel Hill 3 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richa","family":"Gairola","sequence":"additional","affiliation":[{"name":"Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill 4 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Rydberg","sequence":"additional","affiliation":[{"name":"Center for Aging and Health, The University of North Carolina at Chapel Hill 3 , Chapel Hill, NC"},{"name":"Division of Geriatric Medicine, School of Medicine, The University of North Carolina at Chapel Hill 5 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5803-0419","authenticated-orcid":false,"given":"Laura A.","family":"Young","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, School of Medicine, The University of North Carolina at Chapel Hill 2 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Niznik","sequence":"additional","affiliation":[{"name":"Center for Aging and Health, The University of North Carolina at Chapel Hill 3 , Chapel Hill, NC"},{"name":"Division of Geriatric Medicine, School of Medicine, The University of North Carolina at Chapel Hill 5 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"2026061509314199800_B1","unstructured":"Centers for Disease Control and Prevention\n          . National Diabetes Statistics Report. Accessed 14 May 2024. Available from https:\/\/www.cdc.gov\/diabetes\/data\/statistics-report\/index.html"},{"key":"2026061509314199800_B2","unstructured":"Endocrine\n            Society\n          . Diabetes and older adults. Published 5 December 2022. Accessed 14 May 2024. Available from https:\/\/www.endocrine.org\/patient-engagement\/endocrine-library\/diabetes-and-older-adults"},{"key":"2026061509314199800_B3","doi-asserted-by":"crossref","first-page":"S266","DOI":"10.2337\/dc25-S013","article-title":"13. Older adults: Standards of Care in Diabetes\u20142025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"2026061509314199800_B4","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.2337\/dc23-1982","article-title":"Receipt of diabetes specialty care and management services by older adults with diabetes in the U.S., 2015\u20132019: an analysis of Medicare fee-for-service claims","volume":"47","author":"Kahkoska","year":"2024","journal-title":"Diabetes Care"},{"key":"2026061509314199800_B5","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1210\/jc.2019-00198","article-title":"Treatment of diabetes in older adults: an Endocrine Society* clinical practice guideline","volume":"104","author":"LeRoith","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"key":"2026061509314199800_B6","doi-asserted-by":"crossref","first-page":"288","DOI":"10.4338\/ACI-2014-12-RA-0117","article-title":"Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties","volume":"6","author":"Cronin","year":"2015","journal-title":"Appl Clin Inform"},{"key":"2026061509314199800_B7","first-page":"1930","article-title":"Adoption of secure messaging in a patient portal across pediatric specialties","volume":"2016","author":"Masterman","year":"2017","journal-title":"AMIA Annu Symp Proc"},{"key":"2026061509314199800_B8","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1007\/s00464-015-4347-y","article-title":"Rapid growth in surgeons\u2019 use of secure messaging in a patient portal","volume":"30","author":"Shenson","year":"2016","journal-title":"Surg Endosc"},{"key":"2026061509314199800_B9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jadohealth.2017.08.029","article-title":"Increasing patient portal usage: preliminary outcomes from the MyChart genius project","volume":"62","author":"Ramsey","year":"2018","journal-title":"J Adolesc Health"},{"key":"2026061509314199800_B10","first-page":"3","article-title":"Electronic patient portals: patient and provider perceptions","volume":"22","author":"Powell","year":"2018","journal-title":"Online J Nurs Inform"},{"key":"2026061509314199800_B11","doi-asserted-by":"crossref","first-page":"e79413","DOI":"10.2196\/79413","article-title":"Use of and medical decision-making in portal messages among patients with type 2 diabetes: mixed methods study","volume":"27","author":"Liu","year":"2025","journal-title":"J Med Internet Res"},{"key":"2026061509314199800_B12","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/15586898221126816","article-title":"Inductive\/deductive hybrid thematic analysis in mixed methods research","volume":"17","author":"Proudfoot","year":"2023","journal-title":"J Mix Methods Res"},{"key":"2026061509314199800_B13","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.mayocpiqo.2021.07.003","article-title":"Patients\u2019 perspective about the cost of diabetes management: an analysis of online health communities","volume":"5","author":"Gao","year":"2021","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"2026061509314199800_B14","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.2337\/dc20-2708","article-title":"High out-of-pocket health care cost burden among Medicare beneficiaries with diabetes, 1999\u20132017","volume":"44","author":"Park","year":"2021","journal-title":"Diabetes Care"},{"key":"2026061509314199800_B15","first-page":"508","article-title":"Financial hardship from purchasing prescription drugs among older adults in the United States before, during, and after the Medicare Part D \u201cdonut hole\u201d: findings from 1998, 2001, 2015, and 2021","volume":"28","author":"Olson","year":"2022","journal-title":"J Manag Care Spec Pharm"},{"key":"2026061509314199800_B16","first-page":"25642","article-title":"21st Century Cures Act: interoperability, information blocking, and the ONC Health IT Certification Program","volume":"85","author":"U.S. Department of Health and Human Services","year":"2020","journal-title":"Fed Regist"}],"container-title":["Diabetes Obesity and Cardiometabolic CARE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/docm-care\/article-pdf\/1\/3\/374\/861928\/docm250079.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/docm-care\/article-pdf\/1\/3\/374\/861928\/docm250079.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:32:00Z","timestamp":1781530320000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/docm-care\/article\/1\/3\/374\/164704\/Qualitative-Analysis-of-Patient-Portal-Messages"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,4,13]]},"published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.2337\/doc25-0079","relation":{},"ISSN":["3067-3518","3067-3534"],"issn-type":[{"value":"3067-3518","type":"print"},{"value":"3067-3534","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]}}}