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Diabetes Therapy
Published in: Diabetes Therapy 2/2018

Open Access 01-04-2018 | Original Research

Changing Patients’ Treatment Preferences and Values with a Decision Aid for Type 2 Diabetes Mellitus: Results from the Treatment Arm of a Randomized Controlled Trial

Authors: Robert A. Bailey, Alicia C. Shillington, Qing Harshaw, Martha M. Funnell, Jeffrey VanWingen, Nananda Col

Published in: Diabetes Therapy | Issue 2/2018

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Abstract

Introduction

Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments.

Methods

Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options. Participants’ preferences for treatment, decision-making, and the relative importance they placed on various values related to treatment options (e.g., dosing, weight gain, side effects) were assessed before and after interacting with the PDA. Changes from baseline were calculated (post-PDA minus pre-PDA difference) and assessed in univariate generalized linear models exploring associations with patients’ personal values.

Results

Analyses included 114 diverse patients from 27 clinics across the US. The importance of avoiding injections, concern about hypoglycemia, and taking medications only once a day significantly decreased after interacting with the PDA [− 1.1 (p = 0.002), − 1.3 (p < 0.001), − 1.1 (p = 0.004), respectively], while the importance of taking medications that avoided weight gain increased [0.8 (p = 0.004)]. Prior to viewing the PDA, most patients (58.8%) had not begun thinking about the decision of adding a medication, and few (12.3%) indicated that they had already made a decision. Post-PDA, 46.5% could state a medication preference.

Conclusion

The values-focused PDA for T2DM medication intensification prepared patients to make a shared decision with their clinician and changed patients’ values regarding what was important in making that decision. Helping patients understand their options and underlying values can promote shared decision-making and may reduce clinical inertia delaying treatment intensification.

Funding

Janssen Scientific Affairs, LLC.
Footnotes
1
Using a 5-point Likert scale, which was later converted to a 10-point scale to allow for comparisons between assessments.
 
2
The Consumer Assessment of Healthcare Providers and Systems.
 
3
Although not statistically significant, those who reported having made a decision prior to viewing the PDA were the least likely to have a treatment preference after viewing the PDA.
 
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Metadata
Title
Changing Patients’ Treatment Preferences and Values with a Decision Aid for Type 2 Diabetes Mellitus: Results from the Treatment Arm of a Randomized Controlled Trial
Authors
Robert A. Bailey
Alicia C. Shillington
Qing Harshaw
Martha M. Funnell
Jeffrey VanWingen
Nananda Col
Publication date
01-04-2018
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 2/2018
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-018-0391-7

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