PMID- 29536425 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240330 IS - 1869-6953 (Print) IS - 1869-6961 (Electronic) IS - 1869-6961 (Linking) VI - 9 IP - 2 DP - 2018 Apr TI - 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. PG - 803-814 LID - 10.1007/s13300-018-0391-7 [doi] AB - 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. FAU - Bailey, Robert A AU - Bailey RA AD - Janssen Scientific Affairs, LLC, Raritan, NJ, USA. FAU - Shillington, Alicia C AU - Shillington AC AD - EPI-Q Inc, Oak Brook, IL, USA. Alicia.shillington@epi-q.com. FAU - Harshaw, Qing AU - Harshaw Q AD - EPI-Q Inc, Oak Brook, IL, USA. FAU - Funnell, Martha M AU - Funnell MM AD - Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA. FAU - VanWingen, Jeffrey AU - VanWingen J AD - Family Medicine Specialists, Grand Rapids, MI, USA. FAU - Col, Nananda AU - Col N AD - Five Islands Consulting, Georgetown, ME, USA. LA - eng GR - P30 DK092926/DK/NIDDK NIH HHS/United States PT - Journal Article DEP - 20180313 PL - United States TA - Diabetes Ther JT - Diabetes therapy : research, treatment and education of diabetes and related disorders JID - 101539025 PMC - PMC6104284 OTO - NOTNLM OT - Antihyperglycemic medication OT - Patient decision aid OT - Patient values OT - Shared decision-making OT - Type 2 diabetes mellitus OT - Values clarification EDAT- 2018/03/15 06:00 MHDA- 2018/03/15 06:01 PMCR- 2018/03/13 CRDT- 2018/03/15 06:00 PHST- 2018/01/16 00:00 [received] PHST- 2018/03/15 06:00 [pubmed] PHST- 2018/03/15 06:01 [medline] PHST- 2018/03/15 06:00 [entrez] PHST- 2018/03/13 00:00 [pmc-release] AID - 10.1007/s13300-018-0391-7 [pii] AID - 391 [pii] AID - 10.1007/s13300-018-0391-7 [doi] PST - ppublish SO - Diabetes Ther. 2018 Apr;9(2):803-814. doi: 10.1007/s13300-018-0391-7. Epub 2018 Mar 13.