Fig 1.
PRISMA for a systematic review and meta-analysis flow chart for effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients, 2024.
Fig 2.
a. Risk of bias summary: review authors’ judgements about each risk of bias item for each included study. b. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Fig 3.
Funnel plot of comparison: Shared decision-making vs. Usual care effectiveness for glycaemic control in T2DM adult patients, 2024.
This detected publication bias has downgraded the overall level of certainty of the evidence generated by the current meta-analysis.
Table 1.
Characteristics of the studies included in systematic and meta-analysis for the effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients, 2024.
Fig 4.
Comparison of the effectiveness of shared decision-making vs. usual diabetes care for glycaemic control among T2DM adult patients, 2024.
Thus, the pooled mean differences in HbA1c% level were estimated using a random-effects model (REM). As a result, the estimated overall effect showed that the shared decision-making significantly lowered HbA1c by 0.14% compared to usual care in adult patients diagnosed with T2DM, (95% CI = [-0.26, -0.02], P = 0.02).
Fig 5.
Subgroup analysis for mode of intervention to evaluate the effectiveness of SDM for glycaemic control compared to usual care, 2024.
Sub-group analysis was also carried out, and the length of the intervention (follow-up period) was taken into consideration. The follow-up duration was a minimum of three months and a maximum of twenty-four months; the follow-up period’s median was 12 months. As a result, the studies in which the SDM intervention was followed up for ˂12 months significantly reduced HbA1c% by 0.24%, (95% CI = [-0.45, -0.03], P = 0.00). However, the significant reduction in HbA1c% was not observed in group of studies in which the SDM intervention was followed-up for ≥ 12 months (Fig 6).
Fig 6.
Subgroup an analysis for intervention follow-up period to evaluate the effectiveness of SDM for glycaemic control compared to usual care, 2024.
Also, subgroup analysis was performed on the category of the studies based on the baseline HbA1c% level, which showed the studies that included T2DM patients with poorly controlled glycaemic levels (HbA1c ≥ 8%) and patients with well controlled glycaemic levels (HbA1c˂ 8%) (Fig 7).
Fig 7.
Subgroup analysis for HbA1c% baseline level to evaluate the effectiveness of SDM for glycaemic control compared to usual care, 2024.
As a result, in T2DM patients with poorly controlled glycaemic level, shared decision making significantly reduced level of HbA1c by 0.13%, (95% CI = [-0.29, -0.03], P = 0.00). Nevertheless, significant reduction in HbA1c was not observed in T2DM patients with ˂ 8% HbA1c level participating in SDM compared to patients who received usual care.
Fig 8.
Sensitivity analysis using leave-one-out meta-analysis to evaluate the effectiveness of SDM for glycaemic control among adult T2DM patients compared to usual care, 2024.
Table 2.
Summary of findings of GRADE certainty evidence of the meta-analysis for the effectiveness of shared decision-making for glycaemic control compared to usual care among type 2 diabetes mellitus adult patients, 2024.