(CSPOT31) Perspectives of People With Type 2 Diabetes Mellitus Towards a Decision Aid Assessing Preferences of Glucose-Lowering Drugs: The Dilemma of Choosing

Background: Guidelines recommend metformin as initial drug in many people with type 2 diabetes (T2D) and low risk of cardiovascular disease, with the possibility to switch to or add other drug classes in case of persistent hyperglycemia or adverse drug reactions. A decision aid (DA) could be useful to incorporate a patient’s preferences in the decision of which drug class to choose.

Objectives: We developed such a DA and assessed the perspectives of people with T2D towards its comprehensibility and usability.

Methods: The DA consists of a paper-based leaflet followed by a web-based preference elicitation exercise. The leaflet aims at informing patients about drug characteristics (e.g., efficacy, safety). The relative importance of these drug characteristics for each participant are then assessed in the web-based exercise, which results in a ranking of the preferred drug classes (i.e., all currently marketed drug classes other than metformin). A qualitative study using semi-structured interviews was conducted among Dutch patients with T2D who were or had even been under pharmacological treatment for T2D. The audio-recorded interviews were transcribed verbatim. Thematic analysis was conducted.

Results: Fifteen patients participated (median age 64 years, nine women, and most had diabetes >10 years). Risk of hypoglycaemia was most often the characteristic to which patients attached the highest importance (n=5). A glucagon-like peptide-1-antagonist weekly injection fitted best the preferences of most patients (n=8). The interviews revealed improvements for text, pictograms and figures, and formatting, and increased comprehension of how patients completed the DA. Regarding usability, missing information was identified and perspectives were obtained towards the usability of the exercise, usefulness of the DA, and its role in shared-decision making.

Conclusions: The DA was considered promising for shared-decision making but further improvements regarding comprehensibility and usability are needed for which this study provides clear guidance.