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

有妊娠糖尿病史的女性预防糖尿病的共同决策干预措施。

• 批准号: 10521308
• 负责人: OBIDIUGWU KENRIK, DURU
• 金额: $ 56.4万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 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/10521308
• 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; Recommendation; Recording of previous events; Reporting; Risk Factors; Role; Stress; Surveys; Therapeutic Equivalency; Time; Woman; Work; acceptability and feasibility; behavior change; diabetes prevention program; effectiveness testing; evidence base; experience; follow-up; health related quality of life; high risk; improved; incremental cost; lifestyle intervention; lifetime risk; multidisciplinary; pilot test; preference; prevent; program costs; screening; secondary outcome; shared decision making; success; tool; treatment as usual; uptake

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.

项目摘要/摘要 有妊娠糖尿病病史（GDM）的妇女患2型糖尿病的风险很高 （T2DM）。糖尿病预防计划的证据表明，生活方式的改变和二甲双胍在 该人群在临床上等同于 具有GDM历史的女性。这些妇女面临基于证据的偏好敏感决定 替代方案。在这种情况下，共享决策（SDM）是一种有吸引力的方法，使用决策援助 明确地做出决定，用设备来描述可用的选项，引起患者的喜好并提供帮助 患者做出适合他们的明智决定。据我们所知，没有现有的研究 评估具有GDM史的女性中SDM预防糖尿病。 我们的团队在基于团队的SDM预防糖尿病方法方面拥有丰富的经验，我们的先前 工作表明，这种方法导致增加了循证糖尿病预防策略的吸收 （生活方式改变，二甲双胍或两者）以及在更广泛的随访中持续的体重减轻 糖尿病前期的人口。我们还完成了33名具有GDM女性的SDM试点测试 历史，证明可行性和可接受性。在此提案中，我们旨在评估糖尿病的SDM 在两个卫生系统（UCLA和 Intermountain）。药剂师将在加州大学洛杉矶分校实施干预措施，诊所护理经理将实施 Intermountain的干预措施。我们的具体目的如下：测试RCT的有效性 评估SDM预防糖尿病的1）超重/肥胖女性的体重减轻 GDM和血红蛋白A1C在5.7-6.4％，2）使用生活方式改变和/或使用二甲双胍，患者 - 报告的结果（体育锻炼，饮食模式，患者激活，与健康相关的生活质量），年度 后续筛选到T2DM的进展以及随后妊娠的GDM率（探索性 结果）和3）评估每个女性的计划实施成本的增量成本， GDM和血红蛋白A1C在5.7-6.4％之间，成功启动生活方式改变和/或二甲双胍。我们的 应用程序为实施严格的项目提供了一个独特的机会，该项目应对关键领域 有GDM史的女性预防糖尿病的需求，利用我们的卫生系统基础设施和 我们的合作，多学科团队在预防糖尿病方面具有良好的成就记录。这 工作将提供务实，有效和可持续的方法来增加基于证据的糖尿病 具有GDM史的女性预防策略，可以在其他卫生系统中很容易采用。