Skip to main content

Advertisement

SpringerLink
Log in

Shared Decision-Making in Diabetes Care

  • Health Care Delivery Systems and Implementation in Diabetes (EB Morton-Eggleston, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Shared decision-making (SDM) is a collaborative process by which patients and clinicians work together in a deliberative dialogue. The purpose of this dialogue is to identify reasonable management options that best fit and addresses the unique situation of the patient. SDM supports the patient-centered translation of research into practice. SDM also helps implement a core principle of evidence-based medicine: evidence is necessary but never sufficient to make a clinical decision, as consideration of patient values and context is also required. SDM conversations build on a partnership between the patient and the clinician, draw on the body of evidence with regard to the different treatment options, and consider options in light of the values, preferences, and context of the patient. SDM is appropriate for diabetes care because diabetes care often requires consideration of management options that differ in ways that matter to patients, such as the way in which they place significant demands on patient’s life and living. In the last decade, SDM has proven feasible and useful for sharing evidence with patients and for involving patients in making decisions with their clinicians. Health care and clinical policies advocate SDM, but these policies have yet to impact diabetes care. In this paper, we describe what SDM is, its known impact on diabetes care, and needed work to implement this patient-centered approach in the care of the millions of patients with diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1. This article patly describes the important concept of recognition of shared decision making as the pinnacle of patient-centered care.

    Article  CAS  PubMed  Google Scholar 

  2. Djulbegovic B, Guyatt GH. Evidence-based practice is not synonymous with delivery of uniform health care. JAMA. 2014;312(13):1293–4.

    Article  CAS  PubMed  Google Scholar 

  3. Stiggelbout AM, Van der Weijden T, De Wit MP, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:e256. This article describes the perceprtion and realty of use of SDM by clinicians and highlight some best practices.

    Article  CAS  PubMed  Google Scholar 

  4. Elwyn G, Lloyd A, May C, et al. Collaborative deliberation: a model for patient care. Patient Educ Couns. 2014;97(2):158–64.

    Article  PubMed  Google Scholar 

  5. Saulsberry WJ, Coleman CI, Mearns ES, et al. Comparative efficacy and safety of antidiabetic drug regimens added to stable and inadequate metformin and thiazolidinedione therapy in type 2 diabetes. Int J Clin Pract. 2015;198:87–8.

    Google Scholar 

  6. Mearns ES, Saulsberry WJ, White CM, et al. Efficacy and safety of antihyperglycaemic drug regimens added to metformin and sulphonylurea therapy in type 2 diabetes: a network meta-analysis. Diabet Med. 2015.

  7. Monami M, Lamanna C, Marchionni N, et al. Comparison of different drugs as add-on treatments to metformin in type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. 2008;79(2):196–203.

    Article  CAS  PubMed  Google Scholar 

  8. Phung OJ, Scholle JM, Talwar M, et al. Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA. 2010;303(14):1410–8.

    Article  CAS  PubMed  Google Scholar 

  9. Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA. 2008;300(15):1814–6.

    Article  CAS  PubMed  Google Scholar 

  10. Crawley L. Evidence-based medicine: a new paradigm for the patient. JAMA. 1993;269(10):1253. author reply 4.

    Article  CAS  PubMed  Google Scholar 

  11. Davidoff F, Haynes B, Sackett D, et al. Evidence based medicine. BMJ. 1995;310(6987):1085–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71–2.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Richardson PE. David Sackett and the birth of evidence based medicine: how to practice and teach EBM. BMJ. 2015;350:h3089.

    Article  PubMed  Google Scholar 

  14. Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295–6. This article provides an improtant concept of the interdependence of EBM and Shared Decision Making.

    Article  CAS  PubMed  Google Scholar 

  15. Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999;49(5):651–61.

    Article  CAS  PubMed  Google Scholar 

  16. Montori VM, Gafni A, Charles C. A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect. 2006;9(1):25–36.

    Article  PubMed  Google Scholar 

  17. Elwyn G, Frosch D, Volandes AE, et al. Investing in deliberation: a definition and classification of decision support interventions for people facing difficult health decisions. Med Decis Making. 2010;30(6):701–11.

    Article  PubMed  Google Scholar 

  18. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414–31.

    Article  CAS  PubMed  Google Scholar 

  19. van Dieren S, Beulens JW, van der Schouw YT, et al. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil. 2010;17 Suppl 1:S3–8.

    Article  PubMed  Google Scholar 

  20. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14 Suppl 5:S1–85.

    PubMed  Google Scholar 

  21. Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 2015;18(2):141–2.

    Google Scholar 

  22. Muka T, Imo D, Jaspers L, et al. The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol. 2015;30(4):251–77.

    Article  PubMed  Google Scholar 

  23. Kankeu HT, Saksena P, Xu K, et al. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review. Health Res Policy Syst. 2013;11:31.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Naykky Singh-Ospina1* RR-G, Juan P. Brito1. Is the endocrine research pipeline broken?—a systematic evaluation of the Endocrine Society clinical practice guidelines and trial registration.

  25. Kahn SE, Haffner SM, Heise MA, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006;355(23):2427–43.

    Article  CAS  PubMed  Google Scholar 

  26. Bennett WL, Odelola OA, Wilson LM, et al. Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus: a systematic review. Ann Intern Med. 2012;156(1 Pt 1):27–36.

    Article  PubMed  Google Scholar 

  27. Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011;154(9):602–13.

    Article  PubMed Central  PubMed  Google Scholar 

  28. International Diabetes Federation. Global guideline for type 2 diabetes. 2012. http://www.idf.org/global-guideline-type-2-diabetes-2012 Accessed 2015 Sept 10.

  29. Guidelines ADA/EASD 2015. http://www.ndei.org/ADA-EASD-guidelines-hyperglycemia-management-type-2-diabetes-treatment-algorithm-.aspx. Accessed 2015 Sept 10.

  30. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193–203.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.

    Article  PubMed  Google Scholar 

  32. Magnan EM, Palta M, Mahoney JE, et al. The relationship of individual comorbid chronic conditions to diabetes care quality. BMJ Open Diabetes Res Care. 2015;3(1):e000080.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Fortin M, Soubhi H, Hudon C, et al. Multimorbidity’s many challenges. BMJ. 2007;334(7602):1016–7.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Eton DT, Ridgeway JL, Egginton JS, et al. Finalizing a measurement framework for the burden of treatment in complex patients with chronic conditions. Patient Relat Outcome Meas. 2015;6:117–26.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Montori VM, Breslin M, Maleska M, et al. Creating a conversation: insights from the development of a decision aid. PLoS Med. 2007;4(8):e233.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Agoritsas T, Heen AF, Brandt L, et al. Decision aids that really promote shared decision making: the pace quickens. BMJ. 2015;350:g7624.

    Article  PubMed  Google Scholar 

  37. Montori VM, LeBlanc A, Buchholz A, et al. Basing information on comprehensive, critically appraised, and up-to-date syntheses of the scientific evidence: a quality dimension of the International Patient Decision Aid Standards. BMC Med Inform Decis Mak. 2013;13 Suppl 2:S5.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Stacey D, Legare F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;1:CD001431.

    PubMed  Google Scholar 

  39. Mullan RJ, Montori VM, Shah ND, et al. The diabetes mellitus medication choice decision aid: a randomized trial. Arch Intern Med. 2009;169(17):1560–8.

    Article  PubMed  Google Scholar 

  40. Weymiller AJ, Montori VM, Jones LA, et al. Helping patients with type 2 diabetes mellitus make treatment decisions: statin choice randomized trial. Arch Intern Med. 2007;167(10):1076–82.

    Article  CAS  PubMed  Google Scholar 

  41. Mann DM, Ponieman D, Montori VM, et al. The Statin Choice decision aid in primary care: a randomized trial. Patient Educ Couns. 2010;80(1):138–40.

    Article  PubMed  Google Scholar 

  42. Mathers N, Ng CJ, Campbell MJ, et al. Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: a cluster randomised controlled trial (PANDAs) in general practice. BMJ Open. 2012;2(6):e001469.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Branda ME, LeBlanc A, Shah ND, et al. Shared decision making for patients with type 2 diabetes: a randomized trial in primary care. BMC Health Serv Res. 2013;13:301.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Diabetes Decision Aid. Mayo Clinic. http://diabetesdecisionaid.mayoclinic.org/. Accessed 2015 Sept 10.

  45. Statin Decision Aid. Mayo Clinic. http://statindecisionaid.mayoclinic.org/. Accessed 2015 Sept 10.

  46. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011;343:d4169.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Hemmingsen B, Lund SS, Gluud C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;11:CD008143.

    PubMed  Google Scholar 

  48. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Suppl 1):S14–80.

  49. Qaseem A, Vijan S, Snow V, et al. Glycemic control and type 2 diabetes mellitus: the optimal hemoglobin A1c targets. A guidance statement from the American College of Physicians. Ann Intern Med. 2007;147(6):417–22.

    Article  PubMed  Google Scholar 

  50. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2007;2:CD005613.

    PubMed  Google Scholar 

  51. Singh SR, Ahmad F, Lal A, et al. Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis. CMAJ. 2009;180(4):385–97.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Hargraves I, Montori VM. Decision aids, empowerment, and shared decision making. BMJ. 2014;349:g5811.

    Article  PubMed  Google Scholar 

  53. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303(20):2043–50.

    Article  CAS  PubMed  Google Scholar 

  54. Glasgow RE, Klesges LM, Dzewaltowski DA, et al. The future of health behavior change research: what is needed to improve translation of research into health promotion practice? Ann Behav Med. 2004;27(1):3–12.

    Article  PubMed  Google Scholar 

  55. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.

    Article  PubMed  Google Scholar 

  56. Elwyn G, Laitner S, Coulter A, et al. Implementing shared decision making in the NHS. BMJ. 2010;341:c5146.

    Article  PubMed  Google Scholar 

  57. Holmes-Rovner M, Valade D, Orlowski C, et al. Implementing shared decision-making in routine practice: barriers and opportunities. Health Expect. 2000;3(3):182–91.

    Article  PubMed  Google Scholar 

  58. Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services. https://cahps.ahrq.gov/quality-improvement/improvement-guide/browse-interventions/Communication/Shared-Decision-Making/index.html. Accessed 2015 Sept 10.

  59. Institute of Clinical Systems Improvement. https://www.icsi.org/health_initiatives/shared_decision-making/. Accessed 2015 Sept 10.

  60. Patient-Centered Outcomes Research Institute (PCORI). http://www.pcori.org/. Accessed 2015 Sept 10.

  61. American Diabetes Association (ADA). http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=84160. Accessed 2015 Sept 10.

  62. Knowledge evaluation and research unit at Mayo Clinic. http://shareddecisions.mayoclinic.org/. Accessed 2015 Sept 10.

  63. American College of Cardiology (ACC). http://www.acc.org/. Accessed 2015 Sept 10.

  64. Institute of Healthcare Improvement (IHI). http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/VictorMontoriSharedDecisionMaking.aspx. Accessed 2015 Sept 10.

  65. National Health Service. http://sdm.rightcare.nhs.uk/. Accessed 2015 Sept 10.

  66. Legare F, Ratte S, Gravel K, et al. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73(3):526–35.

    Article  PubMed  Google Scholar 

  67. Lee CN, Hultman CS, Sepucha K. Do patients and providers agree about the most important facts and goals for breast reconstruction decisions? Ann Plast Surg. 2010;64(5):563–6.

    CAS  PubMed  Google Scholar 

  68. Mulley AG, Trimble C, Elwyn G. Stop the silent misdiagnosis: patients’ preferences matter. BMJ. 2012;345:e6572.

    Article  PubMed  Google Scholar 

  69. Street Jr RL, Haidet P. How well do doctors know their patients? Factors affecting physician understanding of patients’ health beliefs. J Gen Intern Med. 2011;26(1):21–7.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Legare F, Stacey D, Turcotte S. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014;9:CD006732.

    PubMed  Google Scholar 

  71. Option Grid Collaborative. http://optiongrid.org/option-grids/current-grids. Accessed 2015 Sept 10.

  72. Elwyn G, O'Connor AM, Bennett C, et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One. 2009;4(3):e4705.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

For the last decade, the Patient Advisory Group, a group of patients with diabetes from the community, has met with investigators of the KER Unit at Mayo Clinic to ground their work on what matters to patients. The insights developed here would not have been possible without their generous contribution to the science of health care. Thanks to Michael R. Gionfriddo, Aaron Leppin, M.D., and LeBlanc, Annie, Ph.D. from the KER Unit for their valuable assistance in the manuscript preparation.

Author information

Authors and Affiliations

  1. Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Shrikant Tamhane, Rene Rodriguez-Gutierrez, Ian Hargraves & Victor M. Montori

Authors
  1. Shrikant Tamhane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rene Rodriguez-Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian Hargraves
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Victor M. Montori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor M. Montori.

Ethics declarations

Conflict of Interest

Victor M. Montori and Ian Hargraves work in the KER Unit, a research laboratory of the Mayo Clinic that designs, evaluates, implements, and disseminates shared decision-making tools for patients with diabetes. These tools are made available for free and there is no income that results from these to the authors, other investigators within the KER Unit, or anyone else. Shrikant Tamhane and Rene Rodriguez-Gutierrez are trainees at the KER Unit. Otherwise, these authors declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Health Care Delivery Systems and Implementation in Diabetes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamhane, S., Rodriguez-Gutierrez, R., Hargraves, I. et al. Shared Decision-Making in Diabetes Care. Curr Diab Rep 15, 112 (2015). https://doi.org/10.1007/s11892-015-0688-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-015-0688-0

Keywords

Search

Navigation