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Cited by 21Patient-Provider Communication in HealthcareDiabetes Management and EducationDiabetes Treatment and Management

Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: a systematic review and meta-analysis

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Geta, Edosa Tesfaye, Terefa, Dufera Rikitu, Hailu, Wase Benti, Olani, Wolkite, Merdassa, Emiru, Dessalegn, Markos, Gelchu, Miesa, Diriba, Dereje Chala·2024·PLOS ONE
DOI 10.1371/journal.pone.0306296PMC PMC11290692
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Abstract

Background: In diabetes care and management guidelines, shared decision-making (SDM) implementation is explicitly recommended to help patients and health care providers to make informed shared decisions that enable informed choices and the selection of treatments. Despite widespread calls for SDM to be embedded in health care, there is little evidence to support SDM in the management and care of diabetes. It is still not commonly utilized in routine care settings because its effects remain poorly understood. Hence, the current systematic review and meta-analysis aimed to evaluate the effectiveness of SDM for glycaemic control among type 2 diabetes adult patients. Methods: Literature sources were searched in MEDLINE, PubMed, Cochrane library and HINARI bibliographic databases and Google Scholar. When these records were searched and reviewed, the PICO criteria (P: population, I: intervention, C: comparator, and O: outcome) were applied. The extracted data was exported to RevMan software version 5.4 and STATA 17 for further analysis. The mean differences (MD) of glycated hemoglobin (HbA1c) were pooled using a random effect model (REM), and sub-group analysis were performed to evaluate the effect size differences across the duration of the follow-up period, modes of intervention, and baseline glycated hemoglobin level of patient groups. The sensitivity analysis was performed using a leave-one-out meta-analysis to quantify the impact of each study on the overall effect size in mean difference HbA1c%. Finally, the statistically significant MD of HbA1c% between the intervention groups engaged in SDM and control groups received usual care was declared at P ˂0.05, using a 95% confidence interval (CI). Results: In the database search, 425 records were retrieved, with only 17 RCT studies fulfilling the inclusion criteria and were included in the meta-analysis. A total of 5416 subjects were included, out of which 2782(51.4%) were included in trial arms receiving SDM and 2634(48.6%) were included in usual diabetes care. The Higgins (I 2) test statistics were calculated to be 59.1%, P = 0.002, indicating statistically significant heterogeneity was observed among the included studies, and REM was used as a remedial to estimate the pooled MD of HbA1c% level between patients who participated in SDM and received usual care. As a result, the pooled MD showed that the SDM significantly lowered HbA1c by 0.14% compared to the usual care (95% CI = [-0.26, -0.02], P = 0.02). SDM significantly decreased the level of HbA1c by 0.14% (95% CI = -0.28, -0.01, P = 0.00) when shared decisions were made in person or face-to-face at the point of care, but there was no statistically significant reduction in HbA1c levels when patients were engaged in online SDM. In patients with poorly controlled glycaemic level (≥ 8%), SDM significantly reduced level of HbA1c by 0.13%, 95% CI = [-0.29, -0.03], P = 0.00. However, significant reduction in HbA1c was not observed in patients with ˂ 8%, HbA1c baseline level. Conclusions: Overall, statistically significant reduction of glycated hemoglobin level was observed among T2DM adult patients who participated in shared decision-making compared to those patients who received diabetes usual care that could lead to improved long-term health outcomes, reducing the risk of diabetes-related complications. Therefore, we strongly suggest that health care providers and policy-makers should integrate SDM into diabetes health care and management, and further study should focus on the level of patients’ empowerment, health literacy, and standardization of decision supporting tools to evaluate the effectiveness of SDM in diabetes patients.

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  • In clinical trials, benefits of shared decision-making were limited to individuals with elevated A1C (>8%).

    “though in clinical trials the benefits of shared decision-making were limited to face-to-face discussions (not online encounters) and to individuals with elevated A1C (>8%) (88).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [88]

    The Results (Subgroup analysis; page unavailable) report a significant HbA1c reduction in studies of patients with baseline HbA1c ≥8%, but not in studies of patients below 8%. This supports the general pattern, but the paper uses a ≥8% threshold rather than >8%, and the study-level subgroup result does not establish that benefits were limited to particular individuals. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Use of decision aids in shared decision-making improves A1C in adults with type 2 diabetes.

    “Shared decisionmaking can be facilitated during clinical encounters through use of decision aides and has been shown to improve A1C in adults with type 2 diabetes”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [88]

  • In clinical trials, benefits of shared decision-making were limited to face-to-face discussions, not online encounters.

    “though in clinical trials the benefits of shared decision-making were limited to face-to-face discussions (not online encounters) and to individuals with elevated A1C (>8%) (88).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [88]

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Cited by

Sorted by citations

Authors
Geta, E. T., Terefa, D. R., Hailu, W. B., Olani, W., Merdassa, E., Dessalegn, M., Gelchu, M., & Diriba, D. C.
Affiliations
  • Wollega University (ET)
  • Bule Hora University (ET)
Corresponding author
Geta, Edosa Tesfaye
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2024-07-31
Volume
19
Issue
7
Pages
e0306296
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0306296
PMC
PMC11290692
OpenAlex
W4401170253
Cited by
21
References
6
Citations by year
2026: 9 · 2025: 11 · 2024: 1
FWCI
1.89
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
shared decision-making, type 2 diabetes, glycemic control, HbA1c, patient participation in treatment decisions, usual care comparison, patient-provider communication, diabetes self-management education, patient satisfaction, patient empowerment, patient satisfaction with treatment outcomes
MeSH terms
Decision Making, Shared, Glycemic Control, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans

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