The diabetes mellitus medication choice decision aid: A randomized trial

Rebecca J. Mullan, Victor M. Montori, Nilay D. Shah, Teresa J.H. Christianson, Sandra C. Bryant, Gordon H. Guyatt, Lilisbeth I. Perestelo-Perez, Robert J. Stroebel, Barbara P. Yawn, Victor Yapuncich, Maggie A. Breslin, Laurie Pencille, Steven A. Smith

Research output: Contribution to journalArticle

186 Scopus citations

Abstract

Background: Patient involvement in the choice of antihyperglycemic agents could improve adherence and optimize glycemic control in patients with type 2 diabetes mellitus. Methods: We conducted a pilot, cluster randomized trial of Diabetes Medication Choice, a decision aid that describes 5 antihyperglycemic drugs, their treatment burden (adverse effects, administration, and self-monitoring demands), and impact on hemoglobin A1c (HbA 1c) levels. Twenty-one clinicians were randomized to use the decision aid during the clinical encounter and 19 to dispense usual care and an educational pamphlet. We used surveys and video analysis to assess postvisit decisional outcomes, and medical and pharmacy records to assess 6-month medication adherence and HbA1c levels. Results: Compared with usual care patients (n=37), patients receiving the decision aid (n=48) found the tool more helpful (clustered-adjusted mean difference [AMD] in a 7-point scale, 0.38; 95% confidence interval [CI], 0.04-0.72); had improved knowledge (AMD, 1.10 of 10 questions; 95% CI, 0.11-2.09); and had more involvement in making decisions about diabetes medications (AMD, 21.8 of 100; 95% CI, 13.0-30.5). At 6-month follow-up, both groups had nearly perfect medication use (median, 100% of days covered), with better adherence (AMD, 9% more days covered; 95% CI, 4%-14%) and persistence (AMD, 12 more days covered; 95% CI, 3-21 days) in the usual care group, and no significant impact on HbA1c levels (AMD, 0.01; 95% CI, -0.49 to 0.50). Conclusion: An innovative decision aid effectively involved patients with type 2 diabetes mellitus in decisions about their medications but did not improve adherence or HbA1c levels. Trial Registration: clinicaltrials.gov Identifier: NCT00388050.

Original languageEnglish (US)
Pages (from-to)1560-1568
Number of pages9
JournalArchives of internal medicine
Volume169
Issue number17
DOIs
StatePublished - Oct 14 2009

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ASJC Scopus subject areas

  • Internal Medicine

Cite this

Mullan, R. J., Montori, V. M., Shah, N. D., Christianson, T. J. H., Bryant, S. C., Guyatt, G. H., Perestelo-Perez, L. I., Stroebel, R. J., Yawn, B. P., Yapuncich, V., Breslin, M. A., Pencille, L., & Smith, S. A. (2009). The diabetes mellitus medication choice decision aid: A randomized trial. Archives of internal medicine, 169(17), 1560-1568. https://doi.org/10.1001/archinternmed.2009.293