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Studies A-Z > D > DRN 150 Pandas
Patient Decision Aid for Type 2 Diabetes
Background
Diabetes mellitus (DM) is a growing health problem in England. The UK Prospective Diabetes Study has highlighted the importance of maintaining good blood glucose control in patients with type 2 DM; however, only 56% of people with diabetes achieve an HbA1c of less than 7.5%.
In those in whom dual therapy has been unsuccessful, NICE guidelines recommend adding insulin. However, starting insulin can be a difficult decision for patients. A Patient Decision Aid is a an evidence-based tool to facilitate the process of arriving at an informed, evidence and value-based decision.
Project aims
To develop a patient decision aid and to evaluate its effectiveness in improving decision quality and health outcomes in type 2 diabetic patients who are considering starting insulin treatment.
Outline
The pilot study will involve administering the patient decision aid in
- Five general practices
- Interviewing 10 healthcare professionals (doctors and nurses)
- Interviewing 30 patients with type 2 diabetes who are considering starting on insulin therapy
The main study is a cluster randomised controlled trial involving
- 30 practices.
- 446 patients.
Each practice will recruit 15 participants.
In the intervention group, the participants will use the Patient Decision Aid. In the control group, the patients will undergo treatment as usual.
All patients will be followed up for six months. The Patient Decision Aid will be evaluated by HbA1c measurement at six months.
What is expected of practices?
Pilot study
- 30-minute interview with one GP and one nurse from each practice
- 30-minute interview with six Type 2 diabetic patients who require insulin therapy from each practice
Main study
- A one-hour training session to doctors and nurses on how to use the Patient Decision Aid will be conducted
- Each practice will identify 15 eligible participants from the diabetes register and invite them to participate by telephone or mail
- In the intervention group, participants will use the Patient Decision Aid with the nurse’s assistance [three questionnaires to complete for each patient]
- The GP or nurse will then counsel the participants as in usual practice
There will be a follow-up visit at six months to check the participants’ HbA1c.
Implications for patients
- Identification of type 2 diabetic patients who may benefit from insulin therapy
- Patients may be started on insulin in the Practice or referred to specialist diabetic care as appropriate
- Participants in the intervention group will benefit from the use of the Patient Decision Aid and be supported in making an informed choice
- Participating patients will receive £30 shopping vouchers.
What will the practice be offered?
- The GPs and nurses will be trained how to use the Patient Decision Aid
- The GPs and nurses will engage in shared decision-making with the patients; this in turn will support individual patients in their choice of treatment and adherence to the treatment plan
- The practice will be invited to attend a research seminar where the research findings will be presented
- The practice will be able to continue to use the Patient Decision Aid after the completion of the study
- The practice will receive £150 cash