Shared Decision Making: Aids and Promotion in Clinical Practice Guidelines for Type 2 Diabetes Treatment

Area of Science:

• Medical Guidelines
• Patient-Centered Care
• Health Informatics

Background:

• Type 2 diabetes (T2D) presents a significant global health challenge, necessitating effective management strategies.
• Clinical Practice Guidelines (CPGs) aim to optimize T2D treatment, but challenges remain in tailoring therapies to individual patient needs and preferences.
• Shared Decision Making (SDM) and decision aids are recognized for improving patient engagement and understanding in medical choices.

Purpose of the Study:

• To evaluate the integration of decision aids and the promotion of SDM in international and national CPGs for T2D treatment.
• To identify the presence and quality of decision aids within T2D CPGs.
• To assess the explicit support for SDM in T2D CPGs.

Main Methods:

• A systematic review identified 52 CPGs, with 33 from 20 countries included after applying exclusion criteria and updates.
• Analysis focused on identifying high-quality decision aids, defined by providing absolute risk estimates for therapeutic options.
• Predefined key terms were used to detect explicit support for SDM in the selected CPGs.

Main Results:

• No CPGs contained decision aids meeting the high-quality criteria.
• While 73% of CPGs acknowledged patient values and preferences, referencing SDM, none provided practical tools for its implementation.
• A notable gap exists between the theoretical acknowledgment of SDM and its practical application in T2D CPGs.

Conclusions:

• SDM is theoretically accepted in T2D guidelines, but its practical implementation is insufficient.
• Guideline developers are making progress in including patient-centered elements, but further advancements are required.
• Future T2D CPG development must prioritize rigorously designed decision aids to support informed, value-based patient decisions.