Abstract
ObjectiveAbout 20% of patients with type 2 diabetes achieve all their treatment targets. Shared decision making (SDM) using a support aid based on the 5‐years results of the ADDITION study on multifactorial treatment, could increase this proportion.Research design and methodsCluster‐randomized trial in 35 former ADDITION primary care practices. Practices were randomized to SDM or care as usual (1:1). Both ADDITION and non‐ADDITION type 2 diabetes patients, 60‐80 years, known with diabetes for 8‐12 years, were included. In the intervention group, patients were presented evidence about the relationship between treatment intensity and cardiovascular events. They chose intensive or less intensive treatment and prioritized their targets. After 1 year priorities could be rearranged. Follow‐up: 24 months. Intention‐to‐treat analysis. Main outcome measure: proportion of patients that achieved all three treatment targets.ResultsAt baseline 26.4% in the SDM group (n=72) had already achieved all three treatment goals (CG: 23.5%, n=81). In the SDM group 44 patients chose intensive treatment, 25 continued their former less intensive treatment and three people switched from the more to the less intensive protocol. After 24 months 31.8% of the patients in the SDM group achieved all three treatment targets (CG: 25.3%), RR 1.26 (95% CI 0.81‐1.95). Mean systolic blood pressure decreased in the SDM group (−5.4 mm Hg, P<.01), mean HbA1c and total cholesterol did not change.ConclusionsDespite an already high baseline level of diabetes care, we found strong indications that SDM on both intensity of treatment and prioritizing treatment goals further improved outcomes.
Highlights
The control of type 2 diabetes mellitus (T2DM) involves a complex series of medical decisions with respect to treatment goals, self-care behaviours and medical treatments.[1,2]. It requires frequent follow-up visits with reconsidering treatment priorities and patients’ preferences.[2,3]. The quality of these decisions could influence the appropriate treatment of T2DM.[2,3,4,5]
The general practitioners (GPs) from the control practices were not asked to engage in shared decision making (SDM), nor trained to do so, and they were not offered the decision support aid
Because it became clear that almost 90% of the participants did not smoke and because in the control group there was no specific treatment target formulated for weight loss, we decided to analyze the proportion of patients that achieved treatment goals with respect to HbA1c, SBP and cholesterol levels
Summary
The control of type 2 diabetes mellitus (T2DM) involves a complex series of medical decisions with respect to treatment goals, self-care behaviours and medical treatments.[1,2] It requires frequent follow-up visits with reconsidering treatment priorities and patients’ preferences.[2,3] The quality of these decisions could influence the appropriate treatment of T2DM.[2,3,4,5] Adequate treatment of multiple risk factors can prevent or postpone diabetes related complications.[1,6,7,8]. The GPs from the control practices were not asked to engage in SDM, nor trained to do so, and they were not offered the decision support aid They were requested to treat the patients as they were used to since the ending of the ADDITION study (2009), either following the national guidelines or the ADDITION intensive treatment protocol, each with their respective targets. Primary outcome was the proportion of patients that achieve all three treatment goals for HbA1c, blood pressure and total cholesterol after 24 months. Because it became clear that almost 90% of the participants did not smoke (anymore) and because in the control group there was no specific treatment target formulated for weight loss, we decided to analyze the proportion of patients that achieved treatment goals with respect to HbA1c, SBP and cholesterol levels.
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