Tannaz Moin1,2, O Kenrik Duru3, Norman Turk3, Janet S Chon3, Dominick L Frosch4, Jacqueline M Martin3, Kia Skrine Jeffers3, Yelba Castellon-Lopez3, Chi-Hong Tseng3, Keith Norris3, Carol M Mangione3,5. 1. David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA. tmoin@mednet.ucla.edu. 2. VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA. tmoin@mednet.ucla.edu. 3. David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA. 4. Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA. 5. Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA.
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)).
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)).
Authors: Richard F Hamman; Rena R Wing; Sharon L Edelstein; John M Lachin; George A Bray; Linda Delahanty; Mary Hoskin; Andrea M Kriska; Elizabeth J Mayer-Davis; Xavier Pi-Sunyer; Judith Regensteiner; Beth Venditti; Judith Wylie-Rosett Journal: Diabetes Care Date: 2006-09 Impact factor: 19.112
Authors: Anjali Gopalan; Ilona S Lorincz; Christopher Wirtalla; Steven C Marcus; Judith A Long Journal: Am J Prev Med Date: 2015-06-16 Impact factor: 5.043
Authors: Rachel Willard-Grace; Ellen H Chen; Danielle Hessler; Denise DeVore; Camille Prado; Thomas Bodenheimer; David H Thom Journal: Ann Fam Med Date: 2015-03 Impact factor: 5.166
Authors: Jan D Hirsch; Neil Steers; David S Adler; Grace M Kuo; Candis M Morello; Megan Lang; Renu F Singh; Yelena Wood; Robert M Kaplan; Carol M Mangione Journal: Clin Ther Date: 2014-07-30 Impact factor: 3.393
Authors: William H Herman; Sharon L Edelstein; Robert E Ratner; Maria G Montez; Ronald T Ackermann; Trevor J Orchard; Mary A Foulkes; Ping Zhang; Christopher D Saudek; Morton B Brown Journal: Am J Manag Care Date: 2013 Impact factor: 2.229
Authors: Azzurra Massimi; Corrado De Vito; Ilaria Brufola; Alice Corsaro; Carolina Marzuillo; Giuseppe Migliara; Maria Luisa Rega; Walter Ricciardi; Paolo Villari; Gianfranco Damiani Journal: PLoS One Date: 2017-03-10 Impact factor: 3.240
Authors: Yelba Castellon-Lopez; Kia Skrine Jeffers; O Kenrik Duru; Gerardo Moreno; Tannaz Moin; Jonathan Grotts; Carol M Mangione; Keith C Norris; Ron D Hays Journal: J Gen Intern Med Date: 2020-03-11 Impact factor: 5.128
Authors: Matthew J O'Brien; Kenzie A Cameron; Maria C Vargas; Loretta Mohr; Geoffrey C Williams; Angela Fagerlin; Namratha R Kandula Journal: J Gen Intern Med Date: 2020-06-15 Impact factor: 5.128
Authors: Hemali Panchal; Norman Turk; Tannaz Moin; Carol M Mangione; Amanda Vu; Sarah Amaya; Keith C Norris; Obidiugwu Kenrik Duru Journal: Womens Health Rep (New Rochelle) Date: 2021-04-27
Authors: Janet Williams; Neha Sachdev; Kate Kirley; Tannaz Moin; O Kenrik Duru; Kimberly D Brunisholz; Kelly Sill; Elizabeth Joy; Gina C Aquino; Ameldia R Brown; Christopher O'Connell; Brenda Rea; Holly Craig-Buckholtz; Patricia W Witherspoon; Cindy Bruett Journal: Popul Health Manag Date: 2021-06-23 Impact factor: 2.459