Perceived Impact of Diabetes Genetic Risk Testing Among Patients at High Phenotypic Risk for Type 2 Diabetes

Abstract

OBJECTIVERapid advances in diabetes genetic epidemiology may lead to a new era of “personalized medicine” based on individual genetic risk assessment. There is minimal experience to guide how best to clinically implement such testing so that results (e.g., “higher” or “lower” relative genetic risk) improve rather than reduce patient motivation for behavior change.RESEARCH DESIGN AND METHODSBetween November 2009 and May 2010, we conducted in-depth interviews with 22 overweight participants at high phenotypic risk for type 2 diabetes to explore perceptions of diabetes genetic risk testing compared with currently available prediction using nongenetic risk factors (e.g., family history, abnormal fasting glucose, obesity). We used hypothetical scenarios to specifically investigate the impact of both “higher” and “lower” relative genetic risk results on participants’ views about diabetes prevention.RESULTSMany participants conferred a unique value on personal genetic risk information relative to nongenetic risk based on the perceived scientific certainty and durability of genetic results. In contrast, other participants considered their genetic risk within the overall context of their other measured risk factors. Reactions to diabetes genetic test results differed by current motivation levels. Whereas most subjects reported that “higher” risk results would motivate behavior change, subjects with lower current motivation often reported that “lower” genetic risk results would further reduce their motivation to engage in diabetes prevention behaviors.CONCLUSIONSTo be effective, future clinical implementation of type 2 diabetes genetic risk testing should be individualized based on each patient’s risk perception and current level of motivation to prevent diabetes.

A Qualitative Study of Anticipated Decision Making around Type 2 Diabetes Genetic Testing: the Role of Scientifically Concordant and Discordant Expectations

“…Our qualitative analysis revealed findings that reinforce and augment existing research in several ways. In agreement with previous research (Grant et al, 2009; Haga et al, 2013; Markowitz, Park, Delahanty, O'Brien, & Grant, 2011), the vast majority of our participants believed they would accept genetic testing for T2DM risk if it was offered to them. We further identified two potential decision-making trends: (1) those who identified as non-Hispanic White and (2) those with college-level education (except Mexican Americans) were more likely to reject or feel hesitant about T2DM genetic testing compared to other groups.…”

Rheumatoid arthritis patient perceptions on the value of predictive testing for treatments: a qualitative study

“…These findings highlight the need for careful support to minimise distress for patients and map onto similar issues that have been explored in studies investigating the views of genetic testing in people at risk of inflammatory disease [11–14]. In those studies, a staged approach has been recommended [10, 15] incorporating provision of information prior to testing, providing help to interpret the results [13, 16] and finally offering psychological support [17]. In general, patient understanding of predictive testing is likely to be variable [15] and we recommend that clinics considering offering patients predictive testing pay particular attention to the impact that the negative result might have on the individual patient.…”

Is Genetic testing useful to predict type 2 diabetes?

“…It may encourage patients to engage with their health and risk factors and motivate them for lifestyle modification. 71,72 Clinicians may be able to tailor T2D therapy to individual genotypes. 73 Genotype information does significantly predict T2D, but it is outperformed in adults, at least, by measurements already routinely incorporated into clinical medicine.…”