American Diabetes Month: Shared Decision Making in Action

By Christopher St. Clair, PharmD, ORISE Fellow and Clydette Powell, MD, MPH, FAAP, Director, Division of Health Care Quality, ODPHP

sdmm-overviewEach November, the American Diabetes Association (ADA) sponsors American Diabetes Month — a time for us to come together to help realize ADA’s vision of a life free of diabetes and its burdens.

As part of our participation in American Diabetes Month, we’ve posted resources to help raise awareness about diabetes and encouraged health care providers to help patients with prediabetes and diabetes boost their physical activity. This week, we want to share ODPHP’s eLearning course for providers on preventing adverse drug events (ADEs) in people with diabetes — and talk about one of its main components: shared decision making.

Shared decision making is a patient-centered care communication strategy that encourages providers to inform patients about their options and then involve them in medical decisions — and it’s a key strategy for preventing hypoglycemic ADEs. That’s because applying a shared decision-making process to diabetes care results in individualized glycemic target setting — treatment is based on evidence-based guidelines and patients’ values and preferences.

When patients play an active role in setting their treatment plan, they’re more likely to follow through with it. That’s certainly been the case for Luke Gellar,* who was diagnosed with type 2 diabetes in 2005. We spoke with Gellar recently about the role shared decision making plays in his care. Gellar looks at his relationship with his primary care provider as a partnership — and he says this approach has made all the difference.

Gellar credits his doctor for including him in decisions about his care from the very beginning, when he was diagnosed with prediabetes. From early conversations about lifestyle factors that were contributing to Gellar’s risk for developing diabetes, he felt his doctor wanted to work with him — not simply for him. “I realized he was on the same page as I was, and saying ‘here’s what we can do.’ He laid out the options he thought I could manage, and we tracked against that. We’ve made prescription and activity level adjustments along the way, but we still track against that care plan,” he says.

Gellar emphasizes how important it is for both parties in the patient-provider partnership to take ownership of the role they play in the treatment plan. For Gellar, that involved a lot of changes to his diet and physical activity level — so he was responsible for making daily decisions about his diabetes management. “If I looked at it by way of transactions that happen on a given day, I own those. I make the call, but it’s within support of the broader plan,” he explains.

And that sense of ownership is important, he says. “I know my role in the process and partnership. I walk away from a visit to my doctor understanding where we are, where we’re trying to go, and what it takes on his end and on mine. For example, I take notes on what he should be looking for next time I visit — I can’t imagine that in 3 months he’ll remember everything we discussed in our last appointment. You’ve got to manage him, and he’s got to manage you. That’s how I see it.”

The relationship that Gellar has developed with his doctor is exactly the kind of relationship we’re interested in inspiring with ODPHP’s eLearning course: one based on teamwork, trust, and mutual respect — paving the way for truly patient-centered care. As Gellar says of his own treatment, “It’s individualized. I’m not being managed like a case study — it’s about what’s happening in my body.”

As American Diabetes Month comes to a close, let’s take a moment to recognize that the kind of care Gellar is talking about — individualized, patient-centered care — is exactly what all patients with diabetes deserve.

Sample tweet: This #DiabetesMonth, we reflect on the importance of shared decision making in #diabetes care: #PreventionMatters

* To protect his privacy, we’ve changed the patient’s name.