共同决策在糖尿病预防中的效果：来自前驱糖尿病知情决策和教育（PRIDE）试验的 12 个月结果。
Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial.
机构信息
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.
出版信息
J Gen Intern Med. 2019 Nov;34(11):2652-2659. doi: 10.1007/s11606-019-05238-6. Epub 2019 Aug 30.
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/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
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)).
重要性
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。
目的
测试糖尿病前期 SDM 干预的效果。
设计
集群随机对照试验。
设置
大型区域卫生系统内的 20 个初级保健诊所。
参与者
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
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。
主要结果和测量
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）。
结果
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）。
局限性
常规护理诊所中没有匹配患者的 DPP 供应商参与数据。
结论和相关性
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。
试验注册
该研究在 clinicaltrials.gov 注册（NCT02384109）。
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