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.

项目总结/摘要 有妊娠期糖尿病史的妇女患2型糖尿病的风险很高 （2型糖尿病）。来自糖尿病预防项目的证据表明，生活方式的改变和二甲双胍的使用， 这些人群在临床上是等效的，在以下人群中，每种人群的T2 DM发病率均降低约50%， 有GDM病史的女性这些女性面临着一个偏好敏感的决定， 替代品.在这种情况下，共享决策（SDM）是一种有吸引力的方法，它使用决策辅助工具， 明确决策，平衡地描述可用选项，了解患者偏好，并帮助 病人在知情的情况下做出适合自己的决定。据我们所知，目前还没有研究 评估SDM在有GDM病史的女性中预防糖尿病的作用。 我们的团队在基于团队的SDM方法预防糖尿病方面拥有丰富的经验， 一项研究表明，这种方法可以增加对循证糖尿病预防策略的采用 （生活方式改变，二甲双胍或两者兼而有之）以及12个月随访时的持续体重减轻， 糖尿病前期人群。我们还在33名患有GDM的妇女中完成了SDM的试点测试 历史，证明可行性和可接受性。在这项提案中，我们的目标是评估SDM治疗糖尿病 在两个卫生系统（加州大学洛杉矶分校和 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 在山间的干预我们的具体目标如下：测试RCT的有效性 评价SDM在以下方面预防糖尿病：1）有糖尿病史的超重/肥胖妇女的体重减轻 GDM和血红蛋白A1 c在5.7- 6.4%之间，2）接受生活方式改变和/或使用二甲双胍，患者- 报告的结局（体力活动、饮食模式、患者激活、健康相关生活质量），每年 进展为T2 DM的随访筛查，以及随后妊娠中GDM的发生率（探索性 结果），以及3）评估每名有以下病史的妇女实施方案的增量成本： GDM和血红蛋白A1 c在5.7-6.4%之间，成功开始改变生活方式和/或二甲双胍。我们 应用程序提供了一个独特的机会，以实施一个严格的项目，解决一个关键领域的未满足 需要对有GDM病史的妇女进行糖尿病预防，利用我们的卫生系统基础设施， 我们的合作，多学科团队在糖尿病预防方面取得了很好的成绩。这 工作将提供务实，有效和可持续的方法，以增加循证糖尿病 针对有GDM病史的妇女的预防战略，可在其他卫生系统中随时采用。