What is the Effectiveness of Type 2 Diabetes Related Patient Decision Aids? Secondary Analysis of a Systematic Review.

Introduction: Patient decision aids (PtDAs) are evidence-based interventions to help people faced with difficult healthcare decisions. Little is known about their effectiveness in people facing diabetes related decisions.

Methods: Secondary analysis of RCTs from 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: quality of the decision and decision-making process. Meta-analyses were conducted for similar outcome measures.

Results: Of 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 to usual care, PtDA group reported increased knowledge (MD 16.06, 95%CI 8.38 to23.75) 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 (RR 1.65, 95%CI 1.06 to 2.56). Six studies measured adherence to a chosen option: one reported greater adherence while another reported lower adherence in PtDA versus usual care and remaining four reported no difference.

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