What Is the Effectiveness of Type 2 Diabetes-related Patient Decision Aids? Secondary Analysis of a Systematic Review.

Objectives: Patient decision aids (PtDAs) are evidence-based interventions to help people faced with difficult health-care decisions. Little is known about their effectiveness in people facing diabetes-related decisions. The aim of this study was to evaluate the scope and effectiveness of diabetes-related PtDAs for screening, prevention, and treatment decisions.

Methods: Secondary analysis of randomized controlled studies (RCTs) from the 2024 Cochrane review of PtDAs comparing decisions aids on diabetes screening, prevention, or treatment to usual care (e.g. patient education, no intervention). Two reviewers independently screened citations, extracted data, and assessed study quality. Primary outcomes included quality of the decision and decision-making process. Meta-analyses were conducted for similar outcome measures.

Results: Of the 209 RCTs, 11 eligible studies evaluated diabetes PtDAs for treatment (n=7), screening (n=3), and prevention (n=1). Common decisions were about diabetes treatment intensification (n=4) and statin initiation (n=3) in people with type 2 diabetes. Compared with usual care, the PtDA group reported increased knowledge (mean difference [MD] 16.06, 95% confidence interval [CI] 8.38 to 23.75) and clearer values (MD -7.43, 95% CI -13.23 to -1.63) and no difference in accurate risk perceptions. After removing high-risk-of-bias studies, PtDAs led to fewer patients feeling uninformed about their options (MD -6.38, 95% CI -9.58 to -3.19) and more participants starting new medications (relative risk ratio 1.65, 95% CI 1.06 to 2.56). Six studies measured adherence to a chosen option: 1 reported greater adherence, whereas another reported lower adherence in PtDA vs usual care and the remaining 4 reported no difference.

Conclusions: Patients given PtDAs can improve their knowledge and feel informed and clearer about their values while being more likely to start new medications. Future research can strengthen the certainty of these findings and should explore PtDA use within the chronic disease context.