What question did this study set out to answer?

This trial aims to evaluate the effectiveness of a shared decision-making (SDM) intervention for preventing type 2 diabetes (T2DM) among women with a history of gestational diabetes.

June 7, 2026

1640-P: A Randomized Trial of Shared-Decision Making for Type 2 Diabetes Prevention in Women with a History of Gestational Diabetes

Key Points

This trial aims to evaluate the effectiveness of a shared decision-making (SDM) intervention for preventing type 2 diabetes (T2DM) among women with a history of gestational diabetes.
Conducted a two-site randomized controlled trial comparing SDM intervention with active control.
Pharmacists and nurses provided the SDM intervention using decision aids that presented lifestyle and medication options.
Primary outcome was weight loss of ≥5% after 12 months of follow-up.
Observed a non-significant trend toward ≥5% weight loss in the intervention group (OR 1.76, 0.94-3.30, p=0.08).
Intervention participants were significantly more likely to initiate the Diabetes Prevention Program (OR 2.95, 1.47-5.89, p=0.002) and/or metformin (OR 8.46, 3.58-19.96, p<0.0001).
Intervention group reported consuming ultra-processed foods less frequently than controls (OR 0.53, 0.32-0.88, p=0.01).

Abstract

Introduction and Objective: Women with overweight/obesity, prediabetes and a history of gestational diabetes mellitus (GDM) face a “preference-sensitive” decision for T2DM prevention since both intensive lifestyle intervention/DPP and metformin lower risk of incident T2DM. Methods: In the Gestational diabetes Risk Attenuation for New Diabetes (GRAND) study, we conducted a two-site RCT of SDM intervention vs active control. Pharmacists and nurses delivered the SDM intervention using a decision aid presenting Intensive Lifestyle Intervention/Diabetes Prevention Program (ILI/DPP) and/or metformin as evidence-based, prevention options. Active control participants reviewed print materials with trained research staff. Our primary outcome was ≥5% weight loss over 12 months follow-up. Secondary outcomes included uptake of DPP and/or metformin or dietary and physical activity measures. Multivariate analyses controlled for site and family history of diabetes. Results: Among 247 participants (n=114 intervention, n=133 active control), we observed a nonsignificant trend toward ≥5% weight loss among intervention vs. active control arm (OR 1.76, 0.94-3.30, p=0.08) at 12-months follow-up. Intervention participants were more likely to initiate the DPP (OR 2.95, 1.47-5.89, p=0.002) and/or metformin (OR 8.46, 3.58-19.96, p0.0001) than active control participants. Intervention participants reported eating ultra-processed foods less frequently than active control participants (OR 0.53, 0.32-0.88, p=0.01). Conclusion: Our RCT of a shared decision-making intervention for T2DM prevention for women with overweight/obesity, prediabetes and a history of GDM showed a non-significant trend toward achieving ≥5% weight. However, SDM increased the likelihood of participation in evidence-based prevention options which hold promise to reduce diabetes risk. Disclosure O. Duru: Consultant; Current; Boehringer Ingelheim International GmbH. T. Tibbe: None. L. Wisk: None. C.S. Han: None. A. Moss: None. F. Cheng: None. J. Chon: None. J. Krong: None. S. Liu: None. A. Malone: None. R.P. Maranon: None. C. Mangione: None. K.C. Norris: Consultant; Current; Atlantis Health Care Inc. J. Page: None. S.C. Thomas: Employee; Current; PocketRN. T. Moin: None. Funding NIH/NIDDK (R01DK127733)

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1640-P: A Randomized Trial of Shared-Decision Making for Type 2 Diabetes Prevention in Women with a History of Gestational Diabetes

Key Points

Abstract

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