David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA.
VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA.
J Gen Intern Med. 2019 Nov;34(11):2652-2659. doi: 10.1007/s11606-019-05238-6. Epub 2019 Aug 30.
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.
To test the effectiveness of a prediabetes SDM intervention.
Cluster randomized controlled trial.
Twenty primary care clinics within a large regional health system.
Overweight/obese adults with prediabetes (BMI ≥ 24 kg/m 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 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.
Primary endpoint was uptake of DPP (≥ 9 sessions), metformin, or both strategies at 4 months. Secondary endpoint was weight change (lbs.) at 12 months.
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).
Absence of DPP supplier participation data for matched patients in usual care clinics.
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.
This study was registered at clinicaltrails.gov (NCT02384109)).
强化生活方式改变（例如糖尿病预防计划）和二甲双胍可降低糖尿病前期患者的 2 型糖尿病风险。然而，实际应用率仍然较低。共同决策（SDM）可以提高认识，并帮助患者选择并坚持知情的糖尿病预防选择，这些选择与他们的偏好相符。
测试糖尿病前期 SDM 干预的效果。
集群随机对照试验。
大型区域卫生系统内的 20 个初级保健诊所。
超重/肥胖的糖尿病前期患者（BMI≥24kg/m 和 HbA1c 5.7-6.4%）从 10 个 SDM 干预诊所招募。采用倾向评分匹配从 10 个常规护理诊所中确定对照患者。
干预诊所的患者被邀请参加与药剂师的面对面 SDM 访问，药剂师使用决策辅助工具（DA）来描述糖尿病前期和四种可能的糖尿病预防选择：DPP、DPP±二甲双胍、二甲双胍单药或常规护理。
主要终点是在 4 个月时采用 DPP（≥9 次）、二甲双胍或这两种策略的比例。次要终点是在 12 个月时的体重变化（磅）。
与接受常规护理的对照组（n=1028；38% vs. 2%，p<0.001）相比，接受 SDM 的患者（n=351）采用 DPP 和/或二甲双胍的比例更高。在 12 个月的随访中，与对照组相比，SDM 参与者的体重减轻（磅）更大（-5.3 对-0.2，p<0.001）。
常规护理诊所中没有匹配患者的 DPP 供应商参与数据。
由药剂师主导的糖尿病前期 SDM 干预措施增加了患者对基于证据的糖尿病预防选择的参与度，并且在 4 个月时 DPP 和/或二甲双胍的采用率以及 12 个月时的体重减轻率显著更高。糖尿病前期 SDM 可能是一种有前途的方法，可增强高危患者的预防工作。
该研究在 clinicaltrials.gov 注册（NCT02384109）。
