Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial.
Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. The aim of this study was to assess a personalized Web-based decision support tool.



We randomized physicians and their patients with type 2 diabetes (≥65 years of age) to a 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, and 4) intervention acceptability.



We did not find significant differences in proportions of patients who had an A1C discussion (91% intervention v. 76% control; P = 0.19). Intervention patients had larger declines in the informed subscale of decisional conflict (-20 v. 0, respectively; P = 0.04). There were no significant differences in proportions of patients with changes in goals (49% v. 28%, respectively; P = 0.08). Most intervention patients reported that the tool was easy to use (91%) and helped them to communicate (84%). A limitation was that this was a pilot trial at one academic institution.



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



NCT02169999 ( https://clinicaltrials.gov/show/NCT02169999 ).
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
Elbert S
ES
Huang
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
Aviva G
AG
Nathan
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
Jennifer M
JM
Cooper
Department of Public Health Sciences, University of Chicago, Chicago, IL (SML).
Sang Mee
SM
Lee
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
Na
N
Shin
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
Priya M
PM
John
Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL (WD).
William
W
Dale
Shared Decision Making Resources, Georgetown, ME (NFC).
Nananda F
NF
Col
Section of Hospital Medicine, University of Chicago, Chicago, IL (DOM).
David O
DO
Meltzer
Section of General Internal Medicine, University of Chicago, Chicago, IL (ESH, AGN, JMC, NS, PMJ, MHC).
Marshall H
MH
Chin
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010865:Pilot Projects; D057285:Precision Medicine
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
aging; chronic disease modeling; decision aids; decision support; personalized medicine; randomized trial; type 2 diabetes