Background: Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk, but uptake is low. Our team has shown that shared decision-making (SDM) for diabetes prevention resulted in greater uptake of DPP and/or metformin and weight loss at 12 month follow-up. In this analysis, we examine weight loss at 24 and 36 month follow-up.
Methods: We led a pragmatic cluster RCT in 20 primary care clinics in a regional health system. We enrolled 5overweight/obese adults with prediabetes (BMI ≥ 24 kg/m2, HbA1c 5.7-6.4%) from intervention clinics. We used propensity score matching to select 1,502 control patients from usual care clinics. We assessed the difference in follow-up weight between groups as recorded in the EHR. We adjusted for age, sex, race, and ethnicity and trimmed the top and bottom 2.5% of change in weight to remove outliers. Intervention: A single SDM visit with a pharmacist who used a decision aid to discuss diabetes prevention options: DPP, DPP +/- metformin, metformin only, usual care.
Results: The greater mean 12-month weight loss among intervention participants versus controls (-4.0 lbs, 95% CI -5.1, -2.9) persisted with ongoing follow-up, although there was some weight regain. Specifically, intervention participants maintained greater mean weight loss than controls at 24 months (-3.1 lbs, 95% CI -4.2, -1.9) and 36 months (-2.7 lbs, 95% CI -3.9, -1.4) .
Conclusion: An intervention with a single SDM session increased engagement in evidence-based diabetes prevention, resulting in weight loss that was largely maintained for three years. Prediabetes SDM is a promising approach to enhance prevention among patients at increased diabetes risk. To achieve greater and more sustained weight loss, periodic reinforcement may be required.
O.Duru: None. T.Moin: None. N.Turk: None. C.Tseng: None. K.C.Norris: None. C.Mangione: n/a.
National Institutes of Health (R18DK105464)