ABSTRACT
BACKGROUND: Patient involvement in the choice of antihyperglycemic agents could improve adherence and optimize glycemic control in patients with type 2 diabetes mellitus. METHODS: We conducted a pilot, cluster randomized trial of Diabetes Medication Choice, a decision aid that describes 5 antihyperglycemic drugs, their treatment burden (adverse effects, administration, and self-monitoring demands), and impact on hemoglobin A(1c) (HbA(1c)) levels. Twenty-one clinicians were randomized to use the decision aid during the clinical encounter and 19 to dispense usual care and an educational pamphlet. We used surveys and video analysis to assess postvisit decisional outcomes, and medical and pharmacy records to assess 6-month medication adherence and HbA(1c) levels. RESULTS: Compared with usual care patients (n = 37), patients receiving the decision aid (n = 48) found the tool more helpful (clustered-adjusted mean difference [AMD] in a 7-point scale, 0.38; 95% confidence interval [CI], 0.04-0.72); had improved knowledge (AMD, 1.10 of 10 questions; 95% CI, 0.11-2.09); and had more involvement in making decisions about diabetes medications (AMD, 21.8 of 100; 95% CI, 13.0-30.5). At 6-month follow-up, both groups had nearly perfect medication use (median, 100% of days covered), with better adherence (AMD, 9% more days covered; 95% CI, 4%-14%) and persistence (AMD, 12 more days covered; 95% CI, 3-21 days) in the usual care group, and no significant impact on HbA(1c) levels (AMD, 0.01; 95% CI, -0.49 to 0.50). CONCLUSION: An innovative decision aid effectively involved patients with type 2 diabetes mellitus in decisions about their medications but did not improve adherence or HbA(1c) levels. Trial Registration clinicaltrials.gov Identifier: NCT00388050.
Subject(s)
Choice Behavior , Decision Support Techniques , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Aged , Cluster Analysis , Female , Follow-Up Studies , Glycated Hemoglobin/drug effects , Health Knowledge, Attitudes, Practice , Humans , Male , Medication Adherence , Middle Aged , Outcome Assessment, Health Care , Patient Education as Topic , Patient Participation , Patient Satisfaction , Physician-Patient Relations , Pilot ProjectsABSTRACT
OBJECTIVE: To assess the association between self-assessed stair-climbing limitation and weight control among family medicine patients, after adjustment for age, gender, marital status, body mass index (BMI), and co-morbidity. METHODS: This study was a retrospective analysis of a cohort of 840 adult family medicine patient records drawn from a large family medicine department in Rochester, Minnesota. Weight control was measured as no change or decline in BMI over approximately 1 year. RESULTS: Adjusting for co-morbidity and other confounders using multiple logistic regression analysis revealed that limited stair-climbing ability was unrelated to weight control over approximately 1 year. Instead, patients with BMI > or = 30 were more likely to control their weight (p<0.01), and age exhibited a non-linear relationship with weight control. The odds of weight control were lower for patients between the ages of 36 and 45 years than for those aged 18-35 years (p<0.01). CONCLUSIONS: In our sample of family medicine patients, self-assessed stair-climbing limitations did not preclude weight control. Weight gain prevention programmes might be targeted at patients who are entering middle age.
