Looking Ahead to the ADA Scientific Sessions 2021:
The Critical Role of Shared Decision-Making in Diabetes Care

Janice MacLeod, MA, RD, CDCES, FADCES

With the addition of the InPenTM Smart* Insulin Pen system to the Medtronic portfolio, the team at Medtronic Diabetes has been thinking through how to best help people/the person with diabetes (PWD) and their care teams make informed decisions regarding diabetes technology choices, including the preferred method of insulin delivery. This year at the American Diabetes Association (ADA) Scientific Sessions, Medtronic will be focusing on the importance of meeting people where they are in their diabetes journey by providing them with a range of technology options. Recognizing that every person’s experience with diabetes is different, Medtronic offers a wide technology portfolio seeking to help people achieve their individual goals. With diabetes technology options ranging from smart insulin pens to continuous glucose monitoring and automated insulin pump therapy, the goal is to provide the right solution at the right time for each person.

Diabetes is largely self-managed therefore it is critical that PWD actively participate in decisions about how to best care for their health. Shared Decision-Making (SDM) is key to person-centered care and is included in the ADA Decision Cycle for patient-centered glycemic management.1 SDM has been described as “a collaborative process by which patients and clinicians work together in a deliberative dialogue.” The purpose is to identify the management options that best fit the unique situations of the patient.2 In practice, SDM is a conversation between the clinician and the PWD, establishing mutual trust and respect. Each shares their areas of expertise to together arrive at the best decision for an individual whether the choice is about the best meal planning approach, what therapy option is desired or what technology tools could be the most helpful in diabetes self-management. Incorporating patient values, preferences, and circumstances is probably the most difficult and poorly understood step in SDM.

In a cross-sectional survey of 372 PWT2D, 39% preferred SDM while 50% preferred physician decision-making and 10% preferred patient decision-making. A1C values for patient and physician decision-making were approximately 1.4 and 1.2 times higher, respectively, than those who favored SDM.  Health literacy improved patient’s perceived involvement with SDM.3 In a small research study conducted among 27 African Americans with diabetes, researchers concluded that physicians should incorporate strategies to simultaneously help gain their patients’ trust and encourage shared decision-making to help enhance patient outcomes.4

As a Registered Dietitian Nutritionist (RDN), SDM has been critical to my practice. People may be OK with a clinician telling them what pill to take. But they are definitely not OK with the RDN or anyone else telling them what or what not to eat. It is too personal. As the diabetes clinician, my job is to share my clinical expertise and experience and my knowledge of the current evidence and standards of care. But it is also important to recognize there is another expert in the room; the PWD is the expert in their life. As the clinician, I need to be skilled in asking the right questions that help PWD self-discover their best choices. It is where all of this intersects that the magic happens – true shared decision-making. This is the art of good clinical care (Figure 1).

Shared decision making Venn diagram.

Recently the Association of Diabetes Care & Education Specialists (ADCES) introduced a technology framework, the I-C-C model, as a simple 3-step process for integrating any technology tool into clinical practice.5 SDM is critical at each step including:

I—Identify. Help the PWD learn about their technology options and make informed decisions as a standard of care.

C—Configure. Help the PWD get a strong start with their new technology by assisting them configure the tool to match their care plan and preferences and by guiding their plan to integrate their technology into daily self-care.

C—Collaborate. This is the ongoing, collaborative use of the data (PWD and clinician in partnership) to assess and optimize the care plan. 

Technology alone changes nothing. Ongoing collaborative use of the data, through SDM, allows for timely, persistent, incremental adjustments to the care plan and visibility to assess and address barriers to following the care plan.

At Medtronic Diabetes we are seeking to understand what is needed to help foster SDM in technology choice and ongoing optimal use of technology tools and the resulting data for every PWD. We would value hearing from you regarding your ideas, the SDM tools you have found useful and the resources you would need. We want to help develop, as a standard of care, ways of helping every PWD make informed choices about all aspects of their care, including the diabetes technology tools that will help them the most. We invite you to share your ideas here at the Medtronic Diabetes Idea Lab:

We also encourage you to visit our Medtronic Assurance web page to learn about the various product access programs available to help when cost and insurance coverage of particular products is of concern:

If you are planning to attend the ADA Scientific Sessions this month we cordially invite you to visit the Medtronic Virtual Exhibit, our Product Theater, Shared Decision with Diabetes Technology on Friday, June 25 at 10:00 – 11:00 am ET, and the following posters and oral presentations presenting the latest research regarding Medtronic’s technology portfolio:


First Author/ Submitter

Category / Presentation Info.

Closed-Loop Increases Time-in-Range in Older Adults with Type 1 Diabetes Compared with Sensor-Augmented Pump Therapy: A Randomized Crossover Trial




Sun. 6/27 @ 4:30 pm

Impact of InPen™ smart insulin pen use on real-world glycemic and insulin dosing outcomes in individuals with poorly controlled diabetes




Sun. 6/27 @ 6:15 pm

Glycemic outcomes of new InPen™ smart insulin pen users who received virtual onboarding




Patient Reported Satisfaction During the Medtronic Extended-Wear Infusion Set (EWIS) Pivotal Trial  




Infusion Set Survival and Performance During the Medtronic Extended-Wear Infusion Set (EWIS) Pivotal Trial  




Durable insulin pumps vs. multiple daily injections for type 1 diabetes: Healthcare utilization and A1C




Preclinical study of a combined insulin infusion and glucose sensing device (DUO)




Robust glycemic outcomes after MiniMed™ Advanced Hybrid Closed-Loop (AHCL) System use regardless of previous therapy





Smart insulin pens connect to a mobile app to provide dosing calculations, reminders and CGM system integration.


American Diabetes Association. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes – 2021. Diabetes Care, 2021;44(S1): S40-S52.


Tamhane S, Rodriquez-Gutierrez R, Hargraves I, Montori VM. Shared Decision-Making in Diabetes Care. Curr Diab Rep, 2015;15:112. 


Wang M, Hung L, Lo Y. Glycemic Control in Type 2 Diabetes: Role of Health Literacy and Shared Decision Making. Patient Preferences and Adherence, 2019;13:871-879.


Peek M, Gorawar-Bhat R, Quinn MT, Odoms-Young A, et al.  Patient Trust in Physicians and Shared Decision-Making Among African-Americans with Diabetes. Health Communication, 2013;28(6): 616-623.


Greenwood D, Howell F, Scher LA, Yousef G. A Framework for Optimizing Technology-Enabled Diabetes and Cardiometabolic Care and Education. The Diabetes Educator, 2020;46(4):315-322.