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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)).

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Titel: 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
Publikationsdatum: 30.08.2019
Verlag: Springer US
Erschienen in: Journal of General Internal Medicine / Ausgabe 11/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05238-6

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Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial

Abstract

Importance

Objective

Design

Setting

Participants

Intervention

Main Outcomes and Measures

Results

Limitations

Conclusions and Relevance

Trial Registration

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Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Importance

Objective

Design

Setting

Participants

Intervention

Main Outcomes and Measures

Results

Limitations

Conclusions and Relevance

Trial Registration

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