Shared decision-making enhances prevention efforts in prediabetes
medwireNews: A pharmacist-led shared decision-making (SDM) intervention significantly increases the uptake of lifestyle-change programs and metformin use in patients with prediabetes, results of the PRIDE study show.
The study included 351 patients (mean age 60 years; 59% women) who attended one of 10 clinics randomly assigned to deliver SDM and 1086 propensity matched controls who attended 10 clinics assigned to continue with usual care. All participants had a glycated hemoglobin level of 5.7–6.4% and were overweight or obese.
During the SDM visit a pharmacist explained to patients what prediabetes was and the risks associated with its treatment, and then encouraged them to decide whether they would prefer an intensive lifestyle intervention (the Diabetes Prevention Program [DPP]), metformin, both, or to continue with usual care.
At the end of the visit, 57% chose DPP, 9% chose metformin, 17% chose both, and another 17% preferred to continue with usual care.
During 8 months of follow-up, the individuals in the SDM group were significantly more likely to complete DPP, defined as attending more than nine sessions, and/or take metformin than were the controls, at a rate of 38% versus 2%.
Speaking at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA, Tannaz Moin (University of California, Los Angeles, USA) described this level of uptake as “very, very meaningful.”
In addition, SDM patients had significantly greater weight loss at 12 months than control patients (5.2 versus 0.3 lbs).
According to previously reported DPP data, each 2.2 lbs of weight loss is associated with a 15% reduction in the risk for progression from prediabetes to diabetes, noted Moin.
Therefore, the weight loss observed in the PRIDE study is “a meaningful result for this high-risk group who have both prediabetes and were overweight and obese,” she said.
Moin concluded that her team is “particularly enthusiastic” about these data because “PRIDE was the first example of the use of SDM for prediabetes, and we were able to translate both evidence-based arms of the original DPP trial.”
She added that she would now like to see SDM in prediabetes assimilate into other health systems and suggested that those without pharmacists integrated into primary care could make use of other allied health professionals, such as nurses, to deliver the intervention.
By Laura Cowen
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