Personalized Decision Support in Type 2 Diabetes Mellitus: Current Evidence and Future Directions
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The management of type 2 diabetes comprises a complex series of medical decisions regarding goals of care, self-care behaviors, and medical treatments. The quality of these medical decisions is critical to determining whether an individual diabetes patient is treated appropriately, overtreated, or undertreated. It is hypothesized that the quality of these medical decisions can be enhanced by personalized decision support tools that summarize patient clinical characteristics, treatment preferences, and ancillary data at the point of care. We describe the current state of personalized diabetes decision support on the basis of 13 recently described tools. Three tools provided support for personalized decisions based on preferences, while the remaining 10 provided support for treatment decisions designed to achieve standard diabetes goals. For the tools that supported personalized decisions, patient participation in medical decisions improved. Future decision support tools must be designed to account for both clinical characteristics and patient preferences.
- Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79. CrossRef
- Ismail-Beigi F, Moghissi E, Tiktin M, et al. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011;154:554–9.
- American Diabetes Association. Executive summary: standards of medical care in diabetes--2012. Diabetes Care. 2012;35 Suppl 1:S4–S10.
- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53. CrossRef
- Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–89. CrossRef
- The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72. CrossRef
- Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39. CrossRef
- The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intesive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59. CrossRef
- Stacey D, Bennett CL, Barry MJ, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011;CD001431.
- Corser W, Holmes-Rovner M, Lein C, Gossain V. A shared decision-making primary care intervention for type 2 diabetes. Diabetes Educ. 2007;33:700–8. CrossRef
- •• Mullan RJ, Montori VM, Shah ND, et al. The diabetes mellitus medication choice decision aid. Arch Intern Med. 2009;169:1560–8. This article describes use of a personalized decision support tool that considered patient preferences in treatment decisions. Its use increased patient involvement, as well as aspects of knowledge and acceptability. CrossRef
- Weymiller AJ, Montori VM, Jones LA, et al. Helping patients with type 2 diabetes mellitus make treatment decisions. Arch Intern Med. 2007;167:1076–82. CrossRef
- Nannenga MR, Montori VM, Weymiller AJ, et al. A treatment decision aid may increase patient trust in the diabetes specialist. The Statin Choice randomized trial. Health Expect. 2009;12:38–44. CrossRef
- Abadie R, Weymiller AJ, Tilburt J, et al. Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial. J Eval Clin Pract. 2009;15:492–7. CrossRef
- •• Mann DM, Ponieman D, Montori VM, et al. The Statin Choice decision aid in primary care: a randomized trial. Patient Educ Couns. 2010;80:138–40. This article describes recent use of the Statin Choice tool, an important example of a personalized decision support tool that considers patient preferences in treatment decisions. CrossRef
- Cleveringa FG, Gorter KJ, van den Donk M, Rutten GE. Combined task delegation, computerized decision support, and feedback improve cardiovascular risk for type 2 diabetic patients. Diabetes Care. 2008;31:2273–5. CrossRef
- Holbrook A, Thabane L, Keshavjee K, et al. Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial. CMAJ. 2009;181:37–44.
- Hunt JS, Siemienczuk J, Gillanders W, et al. The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study. Informat Prim Care. 2009;17:165–74.
- Maclean CD, Gagnon M, Callas P, Littenberg B. The Vermont diabetes information system: a cluster randomized trial of a population based decision support system. J Gen Intern Med. 2009;24:1303–10. CrossRef
- Augstein P, Vogt L, Kohnert KD, et al. Translation of personalized decision support into routine diabetes care. J Diabetes Sci Technol. 2010;4:1532–9.
- O'Connor PJ, Sperl-Hillen JM, Rush WA, et al. Impact of electronic health record clinical decision support on diabetes care: a randomized trial. Ann Fam Med. 2011;9:12–21. CrossRef
- Quinn CC, Shardell MD, Terrin ML, et al. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34:1934–42. CrossRef
- Saenz A, Brito M, Moron I, et al. Development and validation of a computer application to aid the physician's decision-making process at the start of and during treatment with insulin in type 2 diabetes: a randomized and controlled trial. J Diabetes Sci Technol. 2012;6:581–8.
- Leal J, Gray AM, Clarke PM. Development of life-expectancy tables for people with type 2 diabetes. Eur Heart J. 2009;30:834–9. CrossRef
- • Rodbard D, Vigersky RA. Design of a decision support system to help clinicians manage glycemia in patients with type 2 diabetes mellitus. J Diabetes Sci Technol. 2011;5:402–11. From the perspective of personalization, this article is important because the tool allows physicians to set hemoglobin A1c and other glycemia goals. This introduces the potential for personalization, if physicians using the tool set glycemic goals on the basis of a consideration of patient clinical factors or preferences.
- Personalized Decision Support in Type 2 Diabetes Mellitus: Current Evidence and Future Directions
Current Diabetes Reports
Volume 13, Issue 2 , pp 205-212
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links
- Type 2 diabetes mellitus
- Decision support
- Decision support tool
- Decision aid
- Personalized decision support
- Industry Sectors