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. 2025 Apr 24.
doi: 10.1007/s11606-025-09509-3. Online ahead of print.

In Pursuit of Person-Centered Medicine: How Do People with Type 2 Diabetes Choose Glucose-Lowering Medications? A Qualitative Study

Elizabeth H Golembiewski  1 , Xinyuan Ning  2 , Mindy M Mickelson  3 , Janet P Gockerman  4 , Michael Tesulov  5 , Bertina Labatte  5 , Rozalina G McCoy  2   6   7   8
Affiliations

In Pursuit of Person-Centered Medicine: How Do People with Type 2 Diabetes Choose Glucose-Lowering Medications? A Qualitative Study

Elizabeth H Golembiewski et al. J Gen Intern Med. .

Abstract

Background: Clinical guidelines recommend person-centered selection of glucose-lowering therapies that takes patient goals, preferences, and needs into consideration. However, there is limited understanding of how patients' preferences and experiences shape their medication choices.

Objective: To explore how individuals with type 2 diabetes (T2D) choose glucose-lowering medications, focusing on their treatment goals, preferences, and alignment between patient and clinician priorities.

Design: Qualitative study.

Participants: Forty adults with T2D at moderate cardiovascular disease risk, currently taking ≥ 1 glucose-lowering medication, recruited from two health systems in the Midwestern and Southern United States.

Approach: Semi-structured individual interviews were conducted to explore factors influencing medication choice, quality of communication with clinicians, and degree of patient-perceived alignment between patient and clinician treatment goals.

Key results: Among the 40 participants, 55% were female with a mean age of 56.1 years (SD 13.6). The majority identified as White (50.0%) or Black (37.5%). Participants emphasized the importance of avoiding specific side effects and achieving efficacy in their T2D medication choices. While participants valued clear and comprehensive information about medications from clinicians, many described unmet needs and often supplemented clinical information with advice from peers and online sources. Perceptions around medication decision-making authority varied, with some participants preferring patient-led choices, others relying on clinician expertise, and many advocating for a collaborative or shared decision-making approach to selecting a T2D medication. Discrepancies were noted between clinical priorities and person-centered outcomes, with patients prioritizing quality of life and manageable treatment regimens over strict clinical targets.

Conclusions: Understanding patient preferences and experiences is crucial for achieving person-centeredness in T2D medication management. Participants described diverse approaches to evaluating glucose-lowering medications, prioritizing quality of life, ease of adherence, and minimizing side effects. Transparent and collaborative communication with clinicians was identified as crucial for aligning treatment plans with patient values.

Keywords: antihyperglycemic medications; patient preferences; patient-clinician communication; qualitative research; shared decision-making; type 2 diabetes.

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Conflict of interest statement

Declarations. Conflict of Interest: Dr. McCoy receives grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute on Aging (NIA); grants and personal fees from the American Diabetes Association (ADA); and personal fees from EmmiEducate and Yale–New Haven Health System outside the submitted work. No other disclosures were reported. Disclaimer: The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or its Methodology Committee.

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