Medical Challenges in Caring for Older Adults With Type 2 Diabetes and Dementia: A Qualitative Interview Study Using SCAT to Compare Primary Care Physicians and Diabetes Specialists in Japan

Background: As populations age, older adults with type 2 diabetes and comorbid dementia are increasing. Dementia can impair diabetes self-management and require physicians to reconsider treatment goals, family involvement, care coordination, and ethical decision-making. However, few studies have explored physicians' specific challenges in such cases, particularly within the Japanese healthcare context. Methods: This qualitative study examined physicians' perceived difficulties in caring for older adults with type 2 diabetes and dementia. Semi-structured interviews were conducted with six primary care physicians and six diabetes specialists in Japan. Transcripts were analyzed using the Steps for Coding and Theorization (SCAT) method to identify recurring themes and compare perspectives across physician groups. Results: Both groups reported challenges related to the gap between ideal and feasible care, dementia-related disruption of self-management, family involvement, emotional burden, and practical treatment adaptations. Primary care physicians more often emphasized preserving dignity, life context, longitudinal relationships, and coordination with other professionals. Diabetes specialists more often emphasized disease-specific uncertainty, treatment-goal adjustment, dementia diagnosis or disclosure, and pragmatic adaptations to maintain safety. Conclusions: Physicians caring for older adults with type 2 diabetes and dementia experience clinical, ethical, relational, and emotional challenges shaped by their roles and practice contexts. These findings highlight the need for educational and organizational support to help physicians negotiate individualized treatment goals, family involvement, and interprofessional coordination in diabetes-dementia care. Future research should evaluate whether such support can reduce physician burden and improve care quality.