Clinical Report: Advancing Person-Centered Diabetes Care

Overview

The QBSafe cluster randomized trial evaluated a conversation-card tool designed to help adults with poorly controlled type 2 diabetes identify priorities for discussion during primary care visits. At 6 months, the intervention did not significantly improve illness and treatment intrusiveness or other reported clinical and patient outcomes, but intervention participants had higher medication adherence and more frequent diabetes medication changes; clinicians also reported greater encounter satisfaction and confidence addressing concerns.

Background

Primary care clinicians manage type 2 diabetes longitudinally while balancing evidence-based recommendations with comorbidities, patient preferences, social circumstances, and daily demands. Limited visit time and competing priorities can make it difficult to identify treatment burden and the concerns patients most want addressed. The QBSafe intervention sought to make care fit patients’ everyday lives by letting them select topics for an explicit visit agenda. This approach relates to shared decision-making, which incorporates patients’ preferences and values into treatment decisions.

Data Highlights

Key Findings

• The trial tested a patient-priority agenda-setting tool in a population with substantial baseline diabetes burden: mean HbA1c was 10%, diabetes distress was moderate, and illness intrusiveness was comparable to levels reported in serious chronic illness.
• At 6 months, the intervention did not significantly improve the primary patient-reported outcome, illness and treatment intrusiveness, or HbA1c, treatment burden, diabetes distress, or quality of life.
• Medication adherence was higher in the intervention group than in controls at 6 months (77.2% vs 64.6%), and diabetes medication changes were more frequent (33.8% vs 23.2%).
• Intervention-group clinicians reported higher encounter satisfaction and greater confidence in addressing patients’ concerns than clinicians providing usual care.
• The cards were discussed during the first half of 88.9% of intervention visits, and encounter duration did not increase.
• The source distinguishes eliciting patient priorities from achieving shared decision-making: identifying what matters to a patient is an initial step, but does not by itself establish that treatment decisions are shared.

Clinical Implications

The trial supports the feasibility of using a structured agenda-setting tool to elicit patient concerns during routine primary care without increasing encounter duration. Its reported medication adherence and medication-change differences occurred alongside no significant improvement in the measured clinical and patient-reported outcomes at 6 months; the source therefore presents these as changes in proximal care processes rather than demonstrated downstream benefit.

Conclusion

QBSafe made patients’ priorities more explicit in primary care visits and was associated with differences in medication adherence and treatment changes, but it did not improve the measured primary or other clinical and patient-reported outcomes at 6 months. The findings distinguish the value of eliciting concerns from the further work of incorporating them into shared treatment decisions.

Related Resources & Content

1. Lipska et al, QBSafe cluster randomized clinical trial, year not provided — Trial of a patient-priority conversation-card tool for adults with type 2 diabetes
2. American Diabetes Association, Standards of Care in Diabetes—2026 — Improving Care and Promoting Health in Populations
3. ASCO Publications, 2024 — Integrating diabetes care into an oncology practice: A patient-centric model of care delivery at a safety-net health system
4. ASCO Publications, 2026 — Putting the Patient at the Center of Patient-Centered Care
5. ASCO Publications — Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study
6. ASCO Publications — Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study
7. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes—2026
8. Integrating diabetes care into an oncology practice: A patient-centric model of care delivery at a safety-net health system
9. Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study
10. Putting the Patient at the Center of Patient-Centered Care
11. CME | NEJM Weekly CME