Erschienen in:
30.08.2019 | Health Policy
Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial
verfasst von:
Tannaz Moin, MD, MBA, MSHS, O. Kenrik Duru, MD, MSHS, Norman Turk, MS, Janet S. Chon, PharmD, Dominick L. Frosch, PhD, Jacqueline M. Martin, BS, Kia Skrine Jeffers, RN, PhD, Yelba Castellon-Lopez, MD, Chi-Hong Tseng, PhD, Keith Norris, MD, PhD, Carol M. Mangione, MD, MSPH
Erschienen in:
Journal of General Internal Medicine
|
Ausgabe 11/2019
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Abstract
Importance
Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences.
Objective
To test the effectiveness of a prediabetes SDM intervention.
Design
Cluster randomized controlled trial.
Setting
Twenty primary care clinics within a large regional health system.
Participants
Overweight/obese adults with prediabetes (BMI ≥ 24 kg/m2 and HbA1c 5.7–6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics.
Intervention
Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention: DPP, DPP ± metformin, metformin only, or usual care.
Main Outcomes and Measures
Primary endpoint was uptake of DPP (≥ 9 sessions), metformin, or both strategies at 4 months. Secondary endpoint was weight change (lbs.) at 12 months.
Results
Uptake of DPP and/or metformin was higher among SDM participants (n = 351) than controls receiving usual care (n = 1028; 38% vs. 2%, p < .001). At 12-month follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (− 5.3 vs. − 0.2, p < .001).
Limitations
Absence of DPP supplier participation data for matched patients in usual care clinics.
Conclusions and Relevance
A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4 months and weight loss at 12 months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk.
Trial Registration
This study was registered at clinicaltrails.gov (
NCT02384109)).