Each patient wants to know which drug, medical device, test, or surgery is best for them. But figuring out what's best can be challenging, particularly for patients with diabetes. They not only have a bewildering array of medications and treatments to choose from, they also must check their blood-glucose levels, follow a proper diet, and get enough exercise to control their diabetes. Patient-centered outcomes research, also known as comparative effectiveness research, can help. Some medications cause weight gain, some more effectively reduce high blood sugar levels than others, while still others can cause low blood sugar.
For patients who need insulin, comparative effectiveness research confirmed that newer premixed insulin is better than diabetes pills at lowering blood sugar. However, this type of insulin is more likely to cause very low blood sugar and cause more weight gain compared with diabetes pills. These are outcomes that are important to patients and their families.
Armed with this comparative information about diabetes medications from AHRQ's reviews of studies on the topic, doctors and patients can discuss the pros and cons of medications to come up with one that best fits that patient's needs and preferences. The research is being used in creative ways. At the Mayo Clinic referred to in our cover story, clinicians have made cards comparing diabetes medications to facilitate conversations with patients about which medication may be best for them.
Through our Effective Health Care Program, the Agency uses patient-centered outcomes research to compare medical approaches for 14 priority conditions Americans care about, including arthritis, cancer, depression, and diabetes. At AHRQ, it's not only what we do before the research starts that sets us apart, it's what we do during and after. In the beginning, we ask for—and get—input from many sources. Physicians, educators, the private sector, advocacy groups, and others are invited to suggest ideas for research topics. When researchers develop drafts of their proposed research questions, we post them online for comments and feedback. To protect against potential conflicts of interest, researchers must disclose potential conflicts of interest.
Every report we produce is peer-reviewed. When the research is complete, the in-depth analysis not only gets published and posted online, the results are shared so that they can be used. For clinicians, we condense the information into two- to four-page fact sheets with the evidence clearly summarized and rated. For clinicians, researchers, and instructors in the medical field, we provide opportunities for continuing education. For patients, we publish brochures and make audiocasts in plain language—in both English and Spanish. Topics for future patient-centered outcomes research include chemotherapies for advanced colorectal cancer, options for urinary incontinence in adult women, and treatments for difficult-to-treat depression.
No matter what the topic is, the research constantly raises more questions, which requires more research. This is okay with us. It's what we do. We're constantly striving to answer the core question: What treatment works best, for whom, and under which circumstances?
Carolyn M. Clancy, M.D.