Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial
Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial
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DOI：
10.1007/s11606-019-05238-6
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发表时间：
2019-11-01
影响因子：
5.7
通讯作者：
Mangione, Carol M.
中科院分区：
文献类型：
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作者：
Moin, Tannaz;Duru, O. Kenrik;Mangione, Carol M.
重要性：强烈改变生活方式（如糖尿病预防计划）和二甲双胍可降低糖尿病前期患者患2型糖尿病的风险。然而，现实世界的使用率仍然很低。共同决策（SDM）可以提高认识，帮助患者选择和遵循符合他们偏好的糖尿病预防的知情选择。目的探讨糖尿病前期SDM干预的有效性。DesignCluster随机对照试验。大型区域卫生系统内的20个初级保健诊所。参与者：来自10个SDM干预诊所的超重/肥胖前驱糖尿病成人（BMI = 24 kg/m(2)， HbA1c为5.7-6.4%）。倾向评分匹配用于识别来自10个常规护理诊所的对照患者。干预临床患者被邀请参加面对面的SDM访问，药剂师使用决策辅助（DA）来描述糖尿病前期和四种可能的糖尿病预防方案：DPP， DPP二甲双胍，单用二甲双胍或常规护理。主要终点是在4个月时服用DPP（>= 9次）、二甲双胍或两种策略。次要终点是12个月时的体重变化（磅）。结果SDM参与者（n =351）服用DPP和/或二甲双胍的比例高于接受常规护理的对照组(n =1028; 38% vs. 2%, p
ImportanceIntensive 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.ObjectiveTo test the effectiveness of a prediabetes SDM intervention.DesignCluster randomized controlled trial.SettingTwenty primary care clinics within a large regional health system.ParticipantsOverweight/obese adults with prediabetes (BMI >= 24 kg/m(2) 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.InterventionIntervention 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 MeasuresPrimary endpoint was uptake of DPP (>= 9 sessions), metformin, or both strategies at 4 months. Secondary endpoint was weight change (lbs.) at 12 months.ResultsUptake of DPP and/or metformin was higher among SDM participants (n =351) than controls receiving usual care (n =1028; 38% vs. 2%, p