Diabetes Genetic Risk Counseling Fails

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HeConnection-Connected-Diabetes Genetic Risk Counseling FailsDiabetes Genetic Risk Counseling Fails to Alter Behavior – Why didn’t genetic risk testing motivate people to make changes?

In a current study, researchers found that genetic risk counseling for diabetes did not significantly change self-reported preventive behaviors or program adherence in overweight patients at risk for developing diabetes.

The researchers wrote, “Patients and providers have both indicated that learning about higher genetic risk results would likely motivate individuals to change their behavior to prevent diabetes.” “This prediction has not yet been convincingly demonstrated in controlled trials.”

Richard W. Grant, MD, MPH, of the division of research at Kaiser Permanente Northern California, and colleagues conducted a randomized trial of 42 patients at higher genetic risk for diabetes, 32 at lower genetic risk for diabetes and 34 untested control patients (n=108; mean age, 57.9 years) from the Diabetes Prevention Program. The study was done to determine whether testing for genetic risk for diabetes and counseling could improve prevention behavior.

According to data, patients attended approximately 6.8 group sessions and lost about 8.5 lb. Thirty-three of 108 patients (30.6%) lost at least 5% of their body weight, researchers wrote.

“Enrollment in the 12-week diabetes prevention program led to small, generally favorable changes in risk perception, motivation (with the exception of exercise), and confidence that were not statistically different comparing higher- or lower-risk result recipients with control participants,” the researchers wrote.

Although these findings are relevant to current literature in translational genomics, Grant and colleagues conclude that such genetic risk testing cannot be recommended in routine clinical visits due to a lack of evidence-based data.

Health-e-Solutions comment: Evidence-based medicine is necessary and beneficial, but it has it limits. In “The Philosophical Limits of Evidence-Based Medicine,” published in Academic Medicine in 1998, Mark R. Tonelli, MD, MA, argues that EBM fails to account for intangible factors in the individual case, in addition to being innately limited in philosophical scope. In other words, EBM cannot replace clinical judgment or account sufficiently for the complexity of individual cases. The limitations of EBM must be acknowledged and addressed so that it can be used effectively and without compromising patient care.

I would think that there is always a group of individuals who will be motivated by knowing their risk. It may not be a large number, but wouldn’t it be prudent to tell those individuals they are at increased risk no matter what the study above showed? This is where the doctor patient relationship should have the discretion to make a judgment call.  Is it possible the study design was not such that it caught the small percentage that is motivated by knowing their risk?

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Diabetes Care, Jan. 2013