Researchers have devised an innovative decision aid that could help involve patients with Type 2 diabetes in decisions about their medications.

Patient involvement in decision making is desirable, but also challenging, note Victor Montori (Mayo Center for Translational Science Activities, Rochester, Minnesota, USA) and colleagues.

“Clinicians seeking to involve patients may not have the skills, time, or tools to do so effectively and efficiently,” they say.

To improve the involvement of patients with Type 2 diabetes in treatment decision making, the team developed the decision aid Diabetes Medication Choice. The tool describes for patients the features of the available antihyperglycemic medication options, including adverse effects, administration, and self-monitoring demands, as well as their impact on hemoglobin A1c (HbA1c) levels.

For the study, 21 clinicians were randomly assigned to use the decision aid during clinical encounters, while 19 clinicians dispensed usual care and an educational pamphlet.

The 38 patients with Type 2 diabetes who received the decision aid found the tool helpful. They also had better knowledge and more involvement in decisions about diabetes medications than the 37 patients receiving usual care.

The OPTION instrument was used to score the patients involvement in video recordings. The overall score was significant higher for patients using the decision aid, at an average of 49.7 out of 100 compared with 27.7 for the control group.

Of the 21 physicians who used the decision aid, 18 (85%) considered it helpful and 19 (90%) said they would use it again. Most said that that they would use the decision aid with patients whose HbA1c levels fluctuated between 7.0% and 9.5% in the past 6 months. Only nine physicians said they would use it with patients with steady HbA1c levels whose condition was improving.

At the 6-month follow-up, both groups of patients had improving glycemic control and nearly perfect medication use with regard to persistence and adherence. Very few participants in either group started treatment with new medications.

“Thus, the tool, while effective in increasing patient involvement, had limited opportunity to improve outcomes in the population studied,” Montori and co-workers concede in the Archives of Internal Medicine.

They add: “It is possible that a different, less-adherent patient population with deteriorating glycemic control might have greater benefit from involvement in decision making.”

In a related editorial, Grace Lin and R Dudley, from the University of California in San Francisco, USA, said that clinical outcomes should not be the only measure of decision aid effectiveness.

“Focusing only on clinical outcomes as the sole arbiter of the effectiveness of decision aids fails to account for the fact that the decision-making process by itself is a key part of improving the quality and patient-centeredness of care,” they wrote.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

The results of a meta-analysis suggest that the benefits of aspirin treatment for cardiovascular (CV) risk reduction are similar for diabetics and nondiabetics.

“Several guidelines, including those of the American Diabetes Association, recommend aspirin for the primary prevention of cardiovascular events in patients with diabetes,” say Victor Montori (Mayo Clinic, Rochester, Minnesota, USA) and colleagues.

However, the findings of several studies previously reported by MedWire News have suggested that diabetics may gain less CV benefit from aspirin therapy than nondiabetics.

To assess this further, Montori and co-workers carried out a meta-analysis of nine randomized controlled trials involving 89,392 participants in total.

To be eligible for analysis, the studies had to have enrolled patients with diabetes and no prior history of myocardial infarction (MI) or stroke and assessed the efficacy of aspirin at any dose. Study duration ranged from 2.3 to 10.1 years, and researchers followed participants up for mortality, MI, and stroke.

As reported in the journal Diabetes Care, the team found that when patients with diabetes who were taking aspirin were compared with nondiabetics taking aspirin there were no statistically significant differences in mortality, MI, or ischemic stroke.

“While there are insufficient data among patients with diabetes to conclusively show a benefit of aspirin therapy for the primary prevention of cardiovascular events, our data suggest, but do not confirm, that the relative benefit of aspirin is similar in patients with and without diabetes,” conclude Montori et al.

“Additional evidence from randomized controlled trials and individual-patient-data meta-analyses may help to further clarify this issue.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

Free abstract

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