Personalized decision support in type 2 diabetes mellitus: current evidence and future directions

Abstract

The management of type 2 diabetes comprises a complex series of medical decisions regarding goals of care, self-care behaviors, and medical treatments. The quality of these medical decisions is critical to determining whether an individual diabetes patient is treated appropriately, overtreated, or undertreated. It is hypothesized that the quality of these medical decisions can be enhanced by personalized decision support tools that summarize patient clinical characteristics, treatment preferences, and ancillary data at the point of care. We describe the current state of personalized diabetes decision support on the basis of 13 recently described tools. Three tools provided support for personalized decisions based on preferences, while the remaining 10 provided support for treatment decisions designed to achieve standard diabetes goals. For the tools that supported personalized decisions, patient participation in medical decisions improved. Future decision support tools must be designed to account for both clinical characteristics and patient preferences.

Conflict of interest statement

Disclosure

Conflicts of interest: M.J. Wilkinson: none;

Figures

Fig. 1

Conceptual framework for describing potential areas of personalization of diabetes care within the clinical decision making process. A = Consideration of clinical factors when determining risk factor goals. B = Consideration of patient preferences when determining risk factor goals. C = Consideration of clinical factors when making treatment decisions. D = Consideration of patient preferences when making treatment decisions. *Examples of risk factor goals: hemoglobin A1c, blood pressure, and cholesterol targets. **Examples of clinical factors: pharmacogenomics, comorbidity, life expectancy, stage of disease