第二型糖尿病之醫病共享決策

Shared Decision Making in the Management of Type 2 Diabetes Mellitus

糖尿病因會造成大小血管併發症的風險及減少健康餘命，是全球重要的公共衛生負擔。台灣目前已有超過220萬糖尿病人口，但血糖控制達標的比率仍有很大的進步空間。糖尿病的治療需要終身生活型態調整及藥物的治療，與病人的價值觀、偏好及生活型態有緊密的相關性，各大治療指引也建議根據病人的臨床狀況，訂定個人化目標與治療計畫，這樣一個複雜的決策過程特別需要醫病共享決策。醫病共享決策模式可顯著的提高病人知識、對風險的認知、及降低決策衝突，但具體執行上要盡可能地讓病患能理解資訊才可達到最大成效。本文旨在闡明如何依據上述原則，進行設計一應用於糖尿病照護時，胰島素注射之醫病共享決策輔助工具。

Diabetes is an important global public health burden due to a high risk of macro- and microvascular complications and a low life expectancy. There are over 2.2 million people with diabetes in Taiwan. But the proportion of patients achieving glycemic control targets still need to be improved. The management of diabetes requires life-long lifestyle modification and medical treatment, which are closely related to the patient's values, preferences and lifestyle. Recent guidelines recommend that individual goals and treatment plans be set according to the patient's clinical condition. This complex decision-making process is particularly necessary for shared decision making (SDM). SDM not only significantly improve patient knowledge, patient risk perception but also help to reduce decisional conflict. To achieve its maximum benefits, it is important for the providers to be sure that they have made the patients fully comprehend the information conveyed. This narrative report is aim to demonstrate how to design a patient decision aid (PDA) for insulin injection in diabetes managements according to the above suggestions.