Intervention Arm: protocol for SDM and implementation of patient’s decision
Diabetes, diabetes
DIABETES, PREDIABETES, DIABETES
Pharmacists or registered nurses trained in SDM will meet face-to-face in a clinical setting or virtually over video with each participant. During the SDM visit, the pharmacist or registered nurse will help the participant move through the steps of the decision process, using the prediabetes DA from After the initial SDM visit, the pharmacist or registered nurse will communicate the participant’s choice of diabetes prevention strategy to their designated primary provider, through a note in the EHR. If the participant chooses DPP, they will receive a list of in-person or online providers registered with the CDC Diabetes Prevention Recognition Program, including the DPP providers most likely to be covered by their insurance. The research team will follow up in 2–3 weeks with each participant who chose lifestyle change to help them navigate initial DPP enrollment. If a CDC-recognized DPP is not covered by a participant’s insurance, they will be provided with self-pay DPP options to enroll in if they are amenable. These self-pay DPP options vary in cost, averaging $290 for the 12-month lifestyle change program. If the participant chooses metformin, pharmacists can prescribe it with the approval of the patient’s physician, and registered nurses will propose the prescription request to the patient’s physician. The goal/prescribed dose will be 2000 mg per day of immediate release metformin. Although 850 mg twice daily of immediate release metformin was used in the original DPP trial, 1000 mg twice daily is a more commonly used dose in clinical practice and more aligned with our pragmatic approach. The UCLA pharmacists and Intermountain registered nurses will also follow up with patients who chose metformin in 2–3 weeks to assess any side effects, which they can help the patient manage by temporarily reducing the metformin dose or using other effective mitigation strategies, such as switching to 1500 mg per day of extended release metformin. For those who cannot tolerate the goal metformin dosage, we will encourage patients to take the maximum tolerated dose.