12/12/2019
Healthwise Communications Team
A groundbreaking new study published in the Journal of General Internal Medicine proves the value of shared decision making for people with prediabetes.
The Prediabetes Informed Decision and Education (PRIDE) Trial, a three-year prediabetes shared decision making (SDM) intervention conducted at UCLA Health, is the first and largest study to date evaluating SDM in prediabetes or diabetes prevention.1
During the study, individuals with prediabetes were invited to a face-to-face SDM visit with a pharmacist, who walked them through a Healthwise decision aid titled “Prediabetes: Which Treatment Should I Use to Prevent Type 2 Diabetes?” The decision aid outlined the pros and cons of two evidence-based options (intensive lifestyle changes and metformin), asked questions about the patients’ feelings, and tested their understanding of what they’d just learned. At the end of the visit, participants discussed their preferences.
As a result, the participants who attended the SDM visits were far more likely to take part in a diabetes prevention program (DPP) than those in the control group. What’s more, when researchers followed up a year later, the participants who took part in the SDM visits had lost more weight.
The Centers for Disease Control says that people with prediabetes can cut their risk of type 2 diabetes by 58% by taking part in a structured lifestyle change program that includes weight loss and exercise.2,3 But according to a 2019 study of 2,341 prediabetics, only 4.2% had ever been referred to a 12-month DPP, and only 2.4% had ever participated in one.4 On the other hand, 39% of the participants in the PRIDE study attended a DPP or chose metformin (or both). Clearly, having these critical conversations can greatly influence patient adherence and self-management.
82% of the participants said the SDM visit helped them better understand their condition.
Shared decision making works particularly well for prediabetes for several reasons. It’s a preference-sensitive condition, and there’s more than one way to manage it, so patients have several options to choose from. And because many people with prediabetes aren’t aware they have the condition or don’t fully understand their diagnosis, there’s an opportunity to educate.
“When there are different management options for a given condition, it’s very important for patients to be fully informed of their options and to be able to choose what works best for them,” said Dr. Tannaz Moin, the lead author of the study.5 “For diabetes prevention, patients can choose intensive lifestyle change, metformin, both, or neither.”
SDM can be delivered by a variety of health professionals, including nurses, techs, and pharmacists. This takes the burden off primary care physicians and opens more avenues to reach patients.
Dr. Kenrik Duru, the study’s co-principal investigator, says that future research will be conducted. "Based on the success of this intervention, our team at UCLA has partnered with Intermountain Healthcare to scale up SDM for diabetes prevention within both health systems, as part of a $1.7 million project funded by the Patient-Centered Outcomes Research Institute (PCORI),” Dr. Duru said.5
While the focus of this study was prediabetes, shared decision making can be successful in a variety of scenarios and health conditions. When patients engage in SDM, they learn about their health, recognize that a decision needs to be made, and are more likely to follow through on their decision.6 To learn more about how to start these conversations and build lasting provider-patient relationships, download our “8 Steps to Shared Decision Making Success” infographic.
1https://link.springer.com/article/10.1007/s11606-019-05238-6 2https://www.cdc.gov/diabetes/prevention/why-offer-lcp.htm 3https://www.ajpmonline.org/article/S0749-3797(18)32334-1/fulltext 4https://icer-review.org/wp-content/uploads/2016/05/CTAF_DPP_Draft_Evidence_Report_050916-1.pdf 5https://www.healthwise.org/press/study-links-sdm-to-better-outcomes.aspx 6https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf