Patient-Reported Health Behaviors: Type 2 Diabetes Prevention Strategies Among Women with Prediabetes and a History of Gestational Diabetes

Background/Objective: Women with overweight/obesity, prediabetes, and a history of gestational diabetes (GDM) have a high risk of developing type 2 diabetes (T2DM). Our objective was to determine if participating in a shared decision making (SDM) intervention for T2DM prevention increases engagement with evidence-based strategies shown to lower T2DM risk. Subjects/Methods: We analyzed 2021–2024 survey data from 245 women enrolled in the Gestational diabetes Risk Attenuation of New Diabetes (GRAND) Study which is testing the effectiveness of SDM for T2DM prevention. At baseline and at 6 months, women were surveyed about participation in 6 strategies shown to lower T2D risk: 1) controlling/losing weight, 2) increasing physical activity, 3) reducing fat/calories, 4) participating in the Diabetes Prevention Program (DPP), 5) taking metformin, and 6) taking weight loss medication. We constructed a composite score of these health behaviors and used multivariate logistic regression to examine whether SDM was associated with an increase of ≥ 1 prevention strategy at 6 months follow-up. Main Results After controlling for demographic and clinical factors, SDM was associated with 5.7 times higher odds of adopting at least one additional prevention strategy to reduce T2DM risk compared to the control group (95% CI: 2.8–12.0) and 7.4 times greater odds of taking metformin and/or other weight loss medication at 6 months (95% CI: 3.2–16.7). SDM participants were significantly more likely than control participants to report controlling or losing weight (89% vs. 77%, p = 0.009), increasing physical activity (85% vs 72%, p = 0.018), participating in the DPP (28% vs. 9%, p < 0.001), and/or taking metformin (33% vs. 2%, p < 0.001) at 6 months follow-up. Conclusions: Our study shows that SDM increased patient-reported engagement in evidence-based strategies to lower T2DM risk among women at high risk of developing incident T2DM. SDM may be an optimal way of engaging high risk populations in diabetes prevention efforts nationally.