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

Type 2 diabetes (T2D) is a major global health issue due to its rising prevalence and significant burden in terms of morbidity, mortality, and economic impact. Although the availability of Clinical Practice Guidelines (CPGs) aimed at optimising T2D management, the complexity of therapeutic options and the necessity of tailoring treatment to individual patient preferences pose ongoing challenges. Shared Decision Making (SDM) and the high-quality decision aids have been shown to enhance patient understanding and engagement in medical decisions. This study aimed to assess the presence of decision aids and the promotion of SDM within international and national CPGs for T2D treatment.

Fifty-two CPGs identified in a prior systematic review were re-evaluated. Following the application of exclusion criteria and review of updates, 33 CPGs from 20 countries were included. The analysis focused on identifying high-quality decision aids-defined as those providing absolute risk estimates for therapeutic options-and on detecting explicit support for SDM using predefined key terms.

No CPGs included decision aids that met the criteria for high quality. However, 73% acknowledged the importance of patient values and preferences, incorporating at least one reference to SDM. Despite this, no tools were provided to facilitate the practical implementation of SDM. This finding underscores a persistent gap between the theoretical recognition of SDM and its operational integration into CPGs.

These findings suggest that although the role of SDM is theoretically embraced, its practical application remains insufficient. Efforts from major guideline-developing organisations to improve methodological inclusion of patient-centred elements are encouraging, yet much progress is needed. Future guideline development must prioritise the integration of rigorously designed decision aids to truly support informed, value-based medical decisions in T2D care.