The Impact of Reflective Motivation on the Effect of a Shared Decision Making Intervention for Diabetes Prevention

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 （T2DM）。来自糖尿病预防项目（DPP）的证据表明，生活方式的改变和二甲双胍 在该人群中的使用具有临床等效性，每种药物均使T2 DM的发生率降低约50%; 因此，有GDM病史的妇女面临着在这些基于证据的 替代品.共享决策（SDM）是解决患者选择的一种有吸引力的方法 在两个备选方案之间，使用决策辅助工具使决策明确，用 平衡，引出病人的偏好，并帮助病人作出明智的决定，是正确的。到 据我们所知，目前还没有研究评估SDM在女性糖尿病预防中的作用。 GDM的历史此外，了解这种干预的行动机制将有助于我们 了解这种干预“如何、为什么和对谁有效”，从而提高我们的能力， 利用行为改变策略来改善T2 DM高风险女性的结局， 了解如何在类似的糖尿病预防期间和之后帮助行为适应和维持 干预措施。 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 在更广泛的糖尿病前期人群中，12个月随访时体重持续减轻。本行政 作为补充，我们的目标是使用在父R 01中收集的新数据和现有数据来评估 反思性动机，基于能力，机会，动机和行为（COM-B）模型， 行为，作为SDM干预的调解人和调解人，在女性糖尿病患者中预防糖尿病。 两个卫生系统（UCLA和Intermountain）内的GDM病史。我们的具体目标如下：测试 反思动机的组成部分（感知风险，感知控制[控制点+自我效能]）， SDM干预对糖尿病预防的有效性的修正剂（12岁时体重减轻 月）和次要（体力活动，饮食模式，治疗参与）结果 超重/肥胖女性，有GDM病史，血红蛋白A1 c在5.7-6.4%之间， 随机对照试验;并测试反思动机（患者激活）的组成部分作为有效性的中介， SDM干预糖尿病预防的主要和次要结果， 父RCT。我们的应用程序提供了一个独特的机会，研究机制的鲁棒行为 改变现有严格项目中的干预措施，解决糖尿病中未满足需求的关键领域 预防有GDM病史的妇女，利用我们的卫生系统基础设施和我们的合作， 多学科团队，在糖尿病预防方面有着良好的成就记录。

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 (DPP) indicates that lifestyle change and metformin use in this population are clinically equivalent, each reducing the incidence of T2DM by approximately 50%; women with a GDM history thus face a preference-sensitive decision between these evidence-based alternatives. Shared decision making (SDM) is an attractive approach for addressing the patients’ choice between two alternatives, using a decision aid to make the decision explicit, describe the available options with equipoise, elicit patient preferences, and helping 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. Moreover, understading mechanisms of action of such an intervention will contribute to our understanding of the “how, why and for whom” this intervention is effective, in turn improving our ability to harness behavior change strategies to improve outcomes for women at high risk for T2DM, and increasing knowledge of how to aid behavior adoption and maintenance during and after similar diabetes prevention interventions. 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 and sustained weight loss at 12-month follow-up in a broader population with prediabetes. In this administrative supplement, we aim to use new and existing data collected in the parent R01 to evaluate components of reflective motivation, based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model of behavior, as mediators and moderators of the SDM intervention for diabetes prevention among women with a history of GDM within two health systems (UCLA and Intermountain). Our Specific Aims are as follows: To test components of reflective motivation (perceived risk, perceived control [locus of control + self-efficacy]) as modifiers of the effectiveness of an SDM intervention for diabetes prevention on primary (weight loss at 12 months) and secondary (physical activity, eating patterns, treatment engagement) outcomes among overweight/obese women with a GDM history and hemoglobin A1c between 5.7-6.4% enrolled in the parent RCT; and To test components of reflective motivation (patient activation) as mediators of the effectiveness of an SDM intervention for diabetes prevention on primary and secondary outcomes among women enrolled in the parent RCT. Our application presents a unique opportunity to study mechanisms of a robust behavior change intervention in an existing 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.