Purpose

The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment.

Methods

Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. This pilot study was a single-arm, pretest-posttest trial of 40 adult patients with prediabetes, obesity, and ≥1 office visit within the prior 12 months. Participants reviewed this tool briefly with a study team member, and data were collected on 3 coprimary outcomes: knowledge about T2DM risk, decisional conflict, and intention to adopt treatment. Exploratory outcomes included subsequent documentation of prediabetes in chart notes and adoption of ILIs or metformin.

Results

Almost all participants were women, with nearly half expressing Spanish language preference and low educational attainment. A nonsignificant increase in knowledge was observed across all subgroups. Decisional conflict was significantly reduced from pretest to posttest and was similar between subgroups defined by language preference and educational attainment. While intention to adopt ILIs increased across all subgroups, this change was only significant among Spanish speakers and participants with low educational attainment. At 6 months, 17 participants had subsequent provider documentation of prediabetes, and 12 adopted ILIs or metformin.

Conclusions

The decision aid improved patient-reported outcomes and promoted treatment adoption in a diverse patient sample.

中文翻译：

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初级保健中糖尿病前期决策辅助工具的开发和评估：通过语言偏好和教育程度检查患者报告的结果

目的

本研究的目的是检查一种新型糖尿病前期决策辅助工具在采用强化生活方式干预 (ILI) 和二甲双胍方面的发展和初步有效性。很少有研究关注增加这些循证治疗的采用，特别是在非英语人士和教育程度低的人群中。

方法

研究人员开发了英语和西班牙语决策辅助工具，显示有关 2 型糖尿病 (T2DM) 风险和治疗的信息，以预防 T2DM，并提示患者确定下一步的管理步骤。该试点研究是一项单臂、前后测试验，受试者为 40 名患有糖尿病前期、肥胖症且在过去 12 个月内就诊次数≥1 次的成年患者。参与者与研究团队成员简要回顾了该工具，并收集了 3 个共同主要结果的数据：关于 T2DM 风险的知识、决策冲突和采用治疗的意图。探索性结果包括随后在图表注释中记录前驱糖尿病以及采用 ILI 或二甲双胍。

结果

几乎所有参与者都是女性，近一半的人表示对西班牙语的偏好和教育程度较低。在所有亚组中都观察到知识的非显着增加。从前测到后测，决策冲突显着减少，并且在由语言偏好和教育程度定义的亚组之间相似。虽然所有亚组采用 ILI 的意愿都有所增加，但这种变化仅在讲西班牙语的人和受教育程度较低的参与者中显着。在 6 个月时，17 名参与者获得了糖尿病前期的后续提供者文档，12 名参与者采用了 ILI 或二甲双胍。

结论

决策辅助改善了患者报告的结果，并促进了对不同患者样本的治疗采用。