Lifestyle change (e.g., the DPP) and metformin can reduce diabetes risk. Real-world uptake of both strategies remains low. In a pragmatic, cluster-randomized controlled trial, we tested the effectiveness of a shared decision-making (SDM) intervention. After an in-person SDM visit with a pharmacist, overweight patients with prediabetes (A1c 5.7-6.4%) chose to start DPP, metformin, both strategies, or continue usual care. We randomized 20 primary care clinics to intervention vs. usual care, and enrolled 364 study patients with prediabetes from the 10 intervention clinics. We used propensity score matching to identify 1,086 comparison patients within the 10 usual care clinics. The primary outcome was uptake of any diabetes prevention strategy (DPP +/- metformin) within 8 months of the SDM visit. A secondary outcome was change in weight at 1 year after the SDM visit. We used data from the electronic health record (EHR) together with data from 2 local DPP vendors to assess DPP attendance. We used data from the EHR to track metformin uptake and weight change, and ran generalized estimating equation models that controlled for clustering by clinic. Among 364 intervention patients, 57% chose DPP, 17% chose DPP + metformin, 9% chose metformin, and 17% chose to continue usual care. Intervention patients were more likely to join the DPP and/or take metformin than matched controls, 43% (n=155) vs. 3% (n=36; p<.001). In a complete-case analysis among patients with follow-up weight available in the EHR, weight loss was greater for all intervention patients who had an SDM visit (n=312) vs. control patients (n=841) at 12 months (-5.2 lbs vs. -0.29 lbs, p<.001). A prediabetes SDM intervention can enhance patient engagement in evidence-based therapies to prevent diabetes and can promote weight loss at 12 months. Shared decision making in prediabetes may be a promising approach to enhance prevention efforts among patients at highest risk.


T. Moin: None. N. Turk: None. C. Mangione: None. Y. Castellon-Lopez: None. K. Skrine Jeffers: None. K.C. Norris: Other Relationship; Self; AbbVie Inc.. C. Tseng: None. O. Duru: None.

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