2型糖尿病基因检测与咨询能否降低可改变的风险因素？一项针对退伍军人的随机对照试验。
Does Type 2 Diabetes Genetic Testing and Counseling Reduce Modifiable Risk Factors? A Randomized Controlled Trial of Veterans.
作者信息
Voils Corrine I, Coffman Cynthia J, Grubber Janet M, Edelman David, Sadeghpour Azita, Maciejewski Matthew L, Bolton Jamiyla, Cho Alex, Ginsburg Geoffrey S, Yancy William S
机构信息
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC, 27705, USA.
Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
出版信息
J Gen Intern Med. 2015 Nov;30(11):1591-8. doi: 10.1007/s11606-015-3315-5. Epub 2015 Apr 16.
OBJECTIVE
We examined the clinical utility of supplementing type 2 diabetes mellitus (DM) risk counseling with DM genetic test results and counseling.
RESEARCH DESIGN AND METHODS
In this randomized controlled trial, non-diabetic overweight/obese veteran outpatients aged 21 to 65 years received DM risk estimates for lifetime risk, family history, and fasting plasma glucose, followed by either genetic test results (CR+G; N = 303) or control eye disease counseling (CR+EYE; N = 298). All participants received brief lifestyle counseling encouraging weight loss to reduce the risk of DM.
RESULTS
The mean age was 54 years, 53% of participants were black, and 80% were men. There was no difference between arms in weight (estimated mean difference between CR+G vs. CR+EYE at 3 months = 0.2 kg, 95% CI: -0.3 to 0.7; at 6 months = 0.4 kg, 95 % CI: -0.3 to 1.1), insulin resistance, perceived risk, or physical activity at 3 or 6 months. Calorie and fat intake were lower in the CR+G arm at 3 months (p's ≤ 0.05) but not at 6 months (p's > 0.20).
CONCLUSIONS
Providing patients with genetic test results was not more effective in changing patient behavior to reduce the risk of DM compared to conventional risk counseling.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01060540 http://clinicaltrials.gov/show/NCT01060540.
目的
我们研究了在2型糖尿病（DM）风险咨询中补充DM基因检测结果及咨询的临床实用性。
研究设计与方法
在这项随机对照试验中，年龄在21至65岁之间的非糖尿病超重/肥胖退伍军人门诊患者接受了基于终生风险、家族史和空腹血糖的DM风险评估，随后分别接受基因检测结果（CR+G；N = 303）或对照性眼病咨询（CR+EYE；N = 298）。所有参与者均接受了简短的生活方式咨询，鼓励其减重以降低患DM的风险。
结果
平均年龄为54岁，53%的参与者为黑人，80%为男性。两组在体重（3个月时CR+G与CR+EYE之间的估计平均差异 = 0.2 kg，95%CI：-0.3至0.7；6个月时 = 0.4 kg，95%CI：-0.3至1.1）、胰岛素抵抗、感知风险或3个月或6个月时的身体活动方面无差异。3个月时CR+G组的热量和脂肪摄入量较低（p值≤0.05），但6个月时无差异（p值>0.20）。
结论
与传统风险咨询相比，向患者提供基因检测结果在改变患者行为以降低DM风险方面并不更有效。
试验注册
ClinicalTrials.gov NCT01060540 http://clinicaltrials.gov/show/NCT01060540 。
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