Wu R Ryanne, Myers Rachel A, Hauser Elizabeth R, Vorderstrasse Allison, Cho Alex, Ginsburg Geoffrey S, Orlando Lori A
Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA.
Department of Medicine, Duke University, 411 West Chapel Hill St., Suite 500, Durham, NC, 27701, USA.
J Genet Couns. 2017 Feb;26(1):133-140. doi: 10.1007/s10897-016-9988-z. Epub 2016 Jun 14.
Family health history (FHH) in the context of risk assessment has been shown to positively impact risk perception and behavior change. The added value of genetic risk testing is less certain. The aim of this study was to determine the impact of Type 2 Diabetes (T2D) FHH and genetic risk counseling on behavior and its cognitive precursors. Subjects were non-diabetic patients randomized to counseling that included FHH +/- T2D genetic testing. Measurements included weight, BMI, fasting glucose at baseline and 12 months and behavioral and cognitive precursor (T2D risk perception and control over disease development) surveys at baseline, 3, and 12 months. 391 subjects enrolled of which 312 completed the study. Behavioral and clinical outcomes did not differ across FHH or genetic risk but cognitive precursors did. Higher FHH risk was associated with a stronger perceived T2D risk (p < 0.001) and with a perception of "serious" risk (p < 0.001). Genetic risk did not influence risk perception, but was correlated with an increase in perception of "serious" risk for moderate (p = 0.04) and average FHH risk subjects (p = 0.01), though not for the high FHH risk group. Perceived control over T2D risk was high and not affected by FHH or genetic risk. FHH appears to have a strong impact on cognitive precursors of behavior change, suggesting it could be leveraged to enhance risk counseling, particularly when lifestyle change is desirable. Genetic risk was able to alter perceptions about the seriousness of T2D risk in those with moderate and average FHH risk, suggesting that FHH could be used to selectively identify individuals who may benefit from genetic risk testing.
在风险评估背景下，家族健康史（FHH）已被证明对风险认知和行为改变有积极影响。基因风险检测的附加价值则不太确定。本研究的目的是确定2型糖尿病（T2D）家族健康史和基因风险咨询对行为及其认知先兆的影响。研究对象为非糖尿病患者，他们被随机分配接受包含家族健康史±T2D基因检测的咨询。测量指标包括体重、体重指数（BMI）、基线和12个月时的空腹血糖，以及在基线、3个月和12个月时进行的行为和认知先兆（T2D风险认知以及对疾病发展的控制感）调查。共有391名受试者入组，其中312名完成了研究。行为和临床结果在家族健康史或基因风险方面并无差异，但认知先兆存在差异。较高的家族健康史风险与更强的T2D风险认知相关（p<0.001），也与“严重”风险认知相关（p<0.001）。基因风险并未影响风险认知，但与中度（p = 0.04）和平均家族健康史风险受试者（p = 0.01）的“严重”风险认知增加相关，不过高家族健康史风险组未出现这种情况。对T2D风险的控制感较高，且不受家族健康史或基因风险的影响。家族健康史似乎对行为改变的认知先兆有强烈影响，这表明可以利用它来加强风险咨询，特别是在希望改变生活方式的情况下。基因风险能够改变中度和平均家族健康史风险人群对T2D风险严重性的认知，这表明家族健康史可用于选择性地识别可能从基因风险检测中获益的个体。
