Personalized Genetic Risk Counseling to Motivate Diabetes Prevention
A randomized trial
- Richard W. Grant, MD, MPH1⇓,
- Kelsey E. O’Brien, BA2,
- Jessica L. Waxler, CGC3,
- Jason L. Vassy, MD, MPH, SM2,5,
- Linda M. Delahanty, MS, RD5,6,
- Laurie G. Bissett, MS6,
- Robert C. Green, MD, MPH4,5,7,
- Katherine G. Stember, BA2,
- Candace Guiducci, BS8,
- Elyse R. Park, PHD, MPH5,9,
- Jose C. Florez, MD, PHD5,6,8,10 and
- James B. Meigs, MD, MPH2,5
- 1Division of Research, Kaiser Permanente Northern California, Oakland, California
- 2Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts
- 3Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts;
- 4Partners Center for Personalized Genetic Medicine, Boston, Massachusetts
- 5Harvard Medical School, Boston, Massachusetts
- 6Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
- 7Division of Genetics, Brigham and Women’s Hospital, Boston, Massachusetts
- 8Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
- 9Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts
- 10Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts
- Corresponding author: Richard W. Grant, .
OBJECTIVE To examine whether diabetes genetic risk testing and counseling can improve diabetes prevention behaviors.
RESEARCH DESIGN AND METHODS We conducted a randomized trial of diabetes genetic risk counseling among overweight patients at increased phenotypic risk for type 2 diabetes. Participants were randomly allocated to genetic testing versus no testing. Genetic risk was calculated by summing 36 single nucleotide polymorphisms associated with type 2 diabetes. Participants in the top and bottom score quartiles received individual genetic counseling before being enrolled with untested control participants in a 12-week, validated, diabetes prevention program. Middle-risk quartile participants were not studied further. We examined the effect of this genetic counseling intervention on patient self-reported attitudes, program attendance, and weight loss, separately comparing higher-risk and lower-risk result recipients with control participants.
RESULTS The 108 participants enrolled in the diabetes prevention program included 42 participants at higher diabetes genetic risk, 32 at lower diabetes genetic risk, and 34 untested control subjects. Mean age was 57.9 ± 10.6 years, 61% were men, and average BMI was 34.8 kg/m2, with no differences among randomization groups. Participants attended 6.8 ± 4.3 group sessions and lost 8.5 ± 10.1 pounds, with 33 of 108 (30.6%) losing ≥5% body weight. There were few statistically significant differences in self-reported motivation, program attendance, or mean weight loss when higher-risk recipients and lower-risk recipients were compared with control subjects (P > 0.05 for all but one comparison).
CONCLUSIONS Diabetes genetic risk counseling with currently available variants does not significantly alter self-reported motivation or prevention program adherence for overweight individuals at risk for diabetes.
- Received May 7, 2012.
- Accepted June 28, 2012.
- © 2012 by the American Diabetes Association.
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