Perspectives of People with Type 2 Diabetes Mellitus Towards a Decision Aid Assessing Preferences of Glucose-Lowering Drugs: The Dilemma of Choosing.

Background: Treatment guidelines recommend metformin as initial drug in many people with type 2 diabetes (T2D) and low risk of cardiovascular disease, with the possibility to switch to or add other drug classes. A decision aid (DA) could be useful to incorporate a patient's preferences in the decision of which drug class to choose. We developed such a DA and assessed the perspectives of people with T2D towards its comprehensibility and usability.

Methods: The DA consists of a paper-based leaflet followed by a web-based preference elicitation exercise. The leaflet aims at informing patients about drug characteristics (eg, efficacy, safety). The relative importance of these drug characteristics for each participant are then assessed in a web-based exercise, which results in a ranking of the preferred drug classes. A qualitative study using semi-structured interviews was conducted among Dutch patients with T2D who were or had ever been under pharmacological treatment for T2D. The audio-recorded interviews were transcribed verbatim. Thematic analysis was conducted.

Results: Fifteen patients participated (median age 64 years, nine women, and most had T2D >10 years). Risk of hypoglycaemia was most often the characteristic to which patients attached the highest importance (n=5). A glucagon-like peptide-1-antagonist weekly injection fitted best the preferences of most patients (n=8). The interviews revealed improvements for text, pictograms and figures, and formatting, and increased comprehension of how patients completed the DA. Regarding usability, missing information was identified, as well as patients' perspectives about the usefulness of the DA and its role in shared-decision making.

Conclusion: The DA was considered promising for shared-decision making but further improvements regarding its comprehensibility and usability are needed, for which this study provides clear guidance.