Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial.
J Gen Intern Med
; 34(11): 2652-2659, 2019 11.
Article
em En
| MEDLINE
| ID: mdl-31471729
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 ANDMEASURES:
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)).Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Estado Pré-Diabético
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Comportamento de Redução do Risco
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Hipoglicemiantes
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Metformina
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Obesidade
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Prognostic_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos