Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial

Med Decis Making. 2017 Jul;37(5):611-617. doi: 10.1177/0272989X16654142. Epub 2016 Jun 16.

Abstract

Background: Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. The aim of this study was to assess a personalized Web-based decision support tool.

Methods: We randomized physicians and their patients with type 2 diabetes (≥65 years of age) to a support tool or educational pamphlet (75:25 patients). Prior to a visit, intervention patients interacted with the tool, which provided personalized risk predictions and elicited treatment preferences. Main outcomes included 1) patient-doctor communication, 2) decisional conflict, 3) changes in goals, and 4) intervention acceptability.

Results: We did not find significant differences in proportions of patients who had an A1C discussion (91% intervention v. 76% control; P = 0.19). Intervention patients had larger declines in the informed subscale of decisional conflict (-20 v. 0, respectively; P = 0.04). There were no significant differences in proportions of patients with changes in goals (49% v. 28%, respectively; P = 0.08). Most intervention patients reported that the tool was easy to use (91%) and helped them to communicate (84%). A limitation was that this was a pilot trial at one academic institution.

Conclusions: Web-based decision support tools may be a practical approach to facilitating the personalization of goals for chronic conditions.

Trial registration: NCT02169999 ( https://clinicaltrials.gov/show/NCT02169999 ).

Keywords: aging; chronic disease modeling; decision aids; decision support; personalized medicine; randomized trial; type 2 diabetes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Pilot Projects
  • Precision Medicine*

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Associated data

  • ClinicalTrials.gov/NCT02169999