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A Shared Decision Making Intervention for Diabetes Prevention in Women with a History of Gestational Diabetes Mellitus.

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基本信息

批准号：
10352442
负责人：
OBIDIUGWU KENRIK, DURU
金额：
$ 57.53万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-02-15 至 2025-11-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10352442
关键词：
Address Adherence Adopted Area Body Weight Body Weight decreased Case Manager Clinic Clinical Communication Cost Analysis Decision Aid Decision Making Diabetes Mellitus Diabetes prevention Eating Equipoise Face Fatigue Gestational Diabetes Glycosylated hemoglobin A Health Benefit Health Personnel Health system Healthcare Healthcare Systems Incidence Infrastructure Intervention Life Style Light Metformin Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Outcome Study Overweight Participant Patient Outcomes Assessments Patient Preferences Patients Pattern Pharmacists Physical activity Population Postpartum Period Prediabetes syndrome Pregnancy Prevention strategy Provider Publishing Randomized Controlled Trials Recording of previous events Reporting Risk Factors Role Stress Surveys Time Woman Work acceptability and feasibility base behavior change diabetes prevention program effectiveness testing evidence base experience follow-up health related quality of life high risk improved lifestyle intervention lifetime risk multidisciplinary pilot test preference prevent program costs screening secondary outcome shared decision making success tool treatment as usual uptake

项目摘要

PROJECT SUMMARY/ABSTRACT Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes (T2DM). Evidence from the Diabetes Prevention Program indicates that lifestyle change and metformin use in this population are clinically equivalent, each reducing the incidence of T2DM by approximately 50% among women with a GDM history. These women face a preference-sensitive decision between the evidence-based alternatives. Shared decision making (SDM) is an attractive approach in this situation, using a decision aid to make the decision explicit, describe the available options with equipoise, elicit patient preferences, and help patients make an informed decision that is right for them. To our knowledge, there are no existing studies evaluating SDM for diabetes prevention among women with a history of GDM. Our team has extensive experience with a team-based SDM approach for diabetes prevention, and our prior work showed that this approach leads to increased uptake of an evidence-based diabetes prevention strategy (lifestyle change, metformin or both) as well as sustained weight loss at 12-month follow-up in a broader population with prediabetes. We have also completed a pilot test of SDM among 33 women with a GDM history, demonstrating feasibility and acceptability. In this proposal, we aim to evaluate SDM for diabetes prevention among women with a history of GDM and prediabetes within two health systems (UCLA and Intermountain). Pharmacists will implement the intervention at UCLA, and clinic care managers will implement the intervention at Intermountain. Our Specific Aims are as follows: To test the effectiveness of an RCT evaluating SDM for diabetes prevention on 1) weight loss among overweight/obese women with a history of GDM and hemoglobin A1c between 5.7-6.4%, 2) uptake of lifestyle change and/or metformin use, patient- reported outcomes (physical activity, eating patterns, patient activation, health-related quality of life), annual follow-up screening for progression to T2DM, and rates of GDM in a subsequent pregnancy (exploratory outcome), and 3) to evaluate the incremental cost of program implementation per woman with a history of GDM and hemoglobin A1c between 5.7-6.4% who successfully initiates lifestyle change and/or metformin. Our application presents a unique opportunity to implement a rigorous project addressing a critical area of unmet need in diabetes prevention for women with history of GDM, leveraging our health system infrastructure and our collaborative, multidisciplinary team with a strong record of accomplishment in diabetes prevention. This work will provide pragmatic, effective and sustainable approaches to increase evidence-based diabetes prevention strategies for women with a history of GDM that can be readily adopted in other health systems.

项目总结/文摘