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01-11-2019 | Metformin | Health Policy

Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial

Published in: Journal of General Internal Medicine | Issue 11/2019

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 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)).

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Title: Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial
Publication date: 01-11-2019
Keywords: Metformin
Care
Prediabetes
Diabetes Prevention
Published in: Journal of General Internal Medicine / Issue 11/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-019-05238-6

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Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial

Abstract

Importance

Objective

Design

Setting

Participants

Intervention

Main Outcomes and Measures

Results

Limitations

Conclusions and Relevance

Trial Registration

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Abstract

Importance

Objective

Design

Setting

Participants

Intervention

Main Outcomes and Measures

Results

Limitations

Conclusions and Relevance

Trial Registration

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