JMIR Publications

ABSTRACT

Background:

Managing type 2 diabetes (T2D) requires progressive lifestyle change and pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find it challenging due to the complexity of continually emerging treatment options.

Objective:

We aimed to use co-design to develop and pretest a prototype clinical decision support tool (Glyc-assist), embedded within the electronic medical record, that uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting HbA1c targets and intensifying treatment together in real-time in the consultation.

Methods:

Literature on T2D-related clinical decision support tools informed the initial Glyc-Assist design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (four GPs, five endocrinologists, three diabetes educators) and six people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to Glyc-Assist. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of Glyc-Assist, and its role in supporting shared decision making and treatment intensification.

Results:

Clinicians and people with T2D believed Glyc-Assist could support shared decision making, although this was not always observed in the mock consultations, and individualised treatment intensification. They recommended that Glyc-Assist include less information, while keeping relevance and credibility, and use graphs and colours to enhance visual appeal. Maintaining autonomy was important to GPs, so they wanted the capacity to override Glyc-Assist’s recommendations when appropriate. Clinicians requested easier screen navigation, and greater prescribing guidance and capabilities.

Conclusions:

Glyc-Assist was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The Glyc-Assist prototype is being refined based on these findings to prepare for quantitative evaluation. Clinical Trial: N/A