shared decision making in diabetes prevention for women with a history of gdm

Conditions: Gestational Diabetes

Summary: gestational diabetes mellitus (gdm) is a risk factor for the development of type 2 diabetes. lifestyle change and metformin are equally effective in preventing diabetes in patients with a history of gdm, so these women should choose a strategy based on their preferences and values, which may vary by race/ethnicity. this proposal will engage 32 women in shared decision making about diabetes prevention.

the diabetes prevention program (dpp) demonstrated that intensive lifestyle change and metformin both prevent or delay type 2 diabetes (t2dm), but uptake of either approach has been minimal. the research team is implementing a shared decision-making (sdm) intervention for diabetes prevention funded by the national institute of diabetes and digestive and kidney disease (niddk; r18 dk105464). in this clinic-based pragmatic trial, the prediabetes informed decisions and education (pride) study, pharmacists engage patients with prediabetes in evidence-based diabetes prevention using an sdm framework. the research team reached the recruitment goal (n=350) more than 15 months ahead of schedule and enrolled 1.5 times the number of projected participants (n=515), including 56% from racial/ethnic minority groups. pride has been highly successful in treatment engagement, as 85% of participants chose either lifestyle change or metformin. furthermore, among patients who have reached 12-month follow-up, pride participants as a group have lost more weight than matched controls (-5.2 lbs. vs. -0.29 lbs., p\<0.001). pride targets both men and women with prediabetes. only five pride participants had a history of gestational diabetes mellitus (gdm) during a prior pregnancy. gdm is more common among minority women and a history of a gdm diagnosis is one of the most significant risk factors for incident type 2 diabetes, increasing the risk of developing t2dm upwards of sevenfold. the research team is planning to pilot an sdm intervention for women with a history of gdm. this project would advance a patient-centered approach to increase uptake of both evidence-based diabetes prevention strategies among the subgroup of minority women at the highest risk of progression to t2dm. in the proposed project, the research team plans to enroll women with a history of gdm in a pilot study, tracking their choice of diabetes prevention strategy and their weight change over time. importantly, the pilot will enable the research team to estimate the sample size for a future, multi-center study to engage women with a history of gdm in sdm for diabetes prevention. the project's specific aim is as follows: in a pilot study, to deliver the tailored intervention to a diverse sample of 32 women with a history of gdm and hemoglobin a1c from 5.7-6.4% who have not yet developed type 2 diabetes, with a sample divided equally between whites, african americans, latinas and asian americans

Eligibility criteria:
inclusion criteria: * overweight or obese (bmi \>25 or \>23 if asian american) * at least 6 weeks post-partum * have a history of gestational diabetes mellitus exclusion criteria: * currently pregnant, * not a ucla health patient * any history of a type 2 diabetes diagnosis, based on billing codes, laboratory values, or taking any antiglycemic medications