Diabetes mellitus (DM) is the fifth greatest cause of death in Taiwan, impacting 2.3 million Taiwanese. Current treatment guidelines recommend lifestyle modification and healthy eating. Nutritional counseling is an important component of diabetes care. Shared decision making (SDM) has shown numerous potential benefits in the management of DM. However, the efficacy of SDM in diabetic nutritional counseling has not been discussed.
The aim of this study was to develop patient decision aids (PDAs) for SDM nutritional counseling and to investigate the efficacy of SDM for patients with DM.
We developed PDAs that demonstrated 10 health behaviors and verified them prior to enrollment. Participants were: people with DM aged 50 or over; taking oral glucose-lowering agents; and with glycated hemoglobin (A1C) ≥ 7. We excluded people with chronic kidney disease or cognitive impairment. Participants were randomly assigned to the experimental and control groups. The experimental group received SDM counseling using the PDAs, while the control group received traditional counseling. The data that we collected before intervention and three months afterwards included questions relating to the frequency of consumption of different foods and exercise, body weight, body mass index (BMI), A1C, low-density lipid (LDL) cholesterol, and triglycerides. We also evaluated the confidence in behavior change and perceived adherence to behavior change.
The SDM and usual care groups were comparable in terrms of gender, age, and education level, but differed in medication (P = 0.04) (Table 1). After the intervention, the experimental group had significantly lower frequency of consumption of sugary drinks (P = 0.04) and fried foods (P = 0.03) than the control group (Table 2 and Figure 1). The experimental group also showed higher confidence (odds ration (OR) = 13.29, P = 0.0002), and perceived adherence (OR = 7.09, P = 0.0005) (Table 3). After controlling for medication, the SDM intervention still had a positive effect on A1C for participants with A1C levels above 8% using the Johnson-Neyman Procedure. No significant differences in body weight, BMI, and lipid profile were noted (Table 4, and Figure 2-1, 2-2).
SDM in diabetic nutritional counseling increases confidence and perceived adherence to healthy lifestyle modifications, but only achieves partial success in terms of a healthy diet and clinical outcomes.