How a prediabetes decision-making aid can facilitate the path to prevention

Research has shown that there is a way for doctors to help prediabetes patients – especially those who do not speak English or are less educated – take the steps they need to stop type 2 diabetes from developing to prevent.

For a study, the results of which were published in the journal The Science of Diabetes Self-Management and Care, English- and Spanish-speaking patients with prediabetes received a one-sided prediabetes decision-making aid. The care tool visually showed the differences in risk of developing type 2 diabetes when a person with prediabetes participated in an intensive lifestyle intervention, took metformin, or did nothing. The decision aid had icons for 100 adults in each category and shaded how many people in each category would later develop diabetes. A short text described each situation.

Open-ended questions have been used on the back of the Decision Support Tool to ask patients to identify needs related to type 2 diabetes prevention and to define the next steps they should take, such as: B. “Talk to my doctor,” “Participate in a diabetes prevention program,” and “Take a medicine to prevent diabetes.” The text was written in simple language and was written at a fourth grade reading level.

The Findings: There was a greater intention to participate in lifestyle interventions in all subgroups, but the increase was only significant in Spanish-speaking participants and those with a low level of education, two groups that the study found to be often underrepresented in clinical research. “Development and evaluation of a prediabetes decision-making aid in primary care: Examination of the results reported by patients according to language preference and level of education.”

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The study was co-written by family doctor Kate Kirley, MD, the AMA’s director for chronic disease prevention. Of the 25 patients who had an office follow-up visit within six months, 32% participated in an intensive lifestyle intervention program and 16% received a prescription for metformin.

“Such decision-making aids, which are effective for underserved groups, can promote health equity in diabetes prevention, which should be the focus of future research,” the study authors write.

Safer decisions

The prediabetes decision aid has also helped remove some of the uncertainties that individuals face when making medical decisions, the study showed.

“The current study found a four times greater reduction in decision-making conflicts than in a recent Cochrane meta-analysis of 115 decision-making aids that cover a wide range of clinical diseases,” the study authors wrote. “This comparison with a large previous literature on decision-making aids underscores the clinical importance of the results of this study.”

With 88 million adults with prediabetes in the United States, finding ways to help patients before they develop type 2 diabetes is important. In this population, the annual risk of developing type 2 diabetes is 5 to 10%. The lifetime risk of developing the disease is up to 70%.

Large clinical studies have shown that intensive lifestyle interventions can reduce the incidence of diabetes by up to 58%; Metformin can reduce the incidence of diabetes by up to 31%. However, recent reports suggest that less than 5% of adults with prediabetes use any of these tools to reduce their risk of developing diabetes, with lower intake and lower weight loss in Hispanic populations and low-educated patients, that is it in the study.

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The study calls for further research to aid decision-making, including examining its effects on long-term changes in patient-reported outcomes, treatment adoption, and metabolic endpoints, including weight and glycemic measurements.

The AMA’s Diabetes Prevention Guide supports doctors and health organizations in defining and implementing evidence-based strategies for diabetes prevention. This comprehensive and tailored approach helps clinics and health organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring high-risk patients to a national DPP program to change their lifestyle based on their individual needs .

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