Evidence-Based PDAs Can Help with Shared Decision-Making in T2DM
Patient-centered care (PCC) has become a central focus in today's healthcare landscape. PCC is “respectful of and responsive to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions.”1 Included in PCC is shared decision-making (SDM), which involves discussing pros and cons of medications and providing clear, comprehensible instructions.2
SDM values are reflected in the recent Standards of Medical Care in Diabetes,3 which recommends including patients with type 2 diabetes mellitus (T2DM) in the selection and sequencing of medications used in conjunction with metformin, taking into account efficacy, cost, side effects, impact on weight, comorbidities, hypoglycemia risk, and patient preferences.
The complexity of T2DM treatments makes it difficult to implement SDM with patients. Antihyperglycemic treatment is typically initiated with metformin.4 As the disease progresses, one or more additional antihyperglycemic agents are added to metformin to achieve or maintain glycemic control. These include dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter-2 (SGLT-2) inhibitors, thiazolidinediones, sulfonylureas, and insulin.4
These treatments “vary in effectiveness, dosing, administration convenience, risk of adverse events, and cost.”5 The vast array of medications, coupled with the decisional domains that must be considered and the risk/benefit analyses of each treatment, makes management decisions increasingly challenging for clinicians to address with their patients.5