Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial

Abstract

Background

Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. We assess a personalized web-based decision support tool.

Design

We randomized physicians and their patients (≥65 years of age) with type 2 diabetes to support tool or educational pamphlet (75:25 patients). Prior to a visit, intervention patients interacted with the tool, which provided personalized risk predictions and elicited treatment preferences. Main outcomes included 1) patient-doctor communication, 2) decisional conflict, 3) changes in goals, 4) intervention acceptability.

Results

We did not find significant differences in proportions of patients that had an A1C discussion (91% intervention vs. 76% control, p=0.19). Intervention patients had larger declines in the Informed Subscale of Decisional Conflict (-20.0 vs. 0, p=0.04). There were no significant differences in proportions of patients with changes in goals (49% vs. 28%, p=0.08). Most intervention patients reported that the tool was easy to use (91%) and helped them to communicate (84%).

Limitations

Pilot trial at one academic institution.

Conclusions

Web-based decision support tools may be a practical approach to facilitating personalization of goals for chronic conditions.

Trial Registration

ClinicalTrials.govNCT02169999, https://clinicaltrials.gov/show/NCT02169999