Journal of Genetic Counseling

, Volume 26, Issue 1, pp 133–140 | Cite as

Impact of Genetic Testing and Family Health History Based Risk Counseling on Behavior Change and Cognitive Precursors for Type 2 Diabetes

  • R. Ryanne Wu
  • Rachel A. Myers
  • Elizabeth R. Hauser
  • Allison Vorderstrasse
  • Alex Cho
  • Geoffrey S. Ginsburg
  • Lori A. Orlando
Original Research

Abstract

Family health history (FHH) in the context of risk assessment has been shown to positively impact risk perception and behavior change. The added value of genetic risk testing is less certain. The aim of this study was to determine the impact of Type 2 Diabetes (T2D) FHH and genetic risk counseling on behavior and its cognitive precursors. Subjects were non-diabetic patients randomized to counseling that included FHH +/− T2D genetic testing. Measurements included weight, BMI, fasting glucose at baseline and 12 months and behavioral and cognitive precursor (T2D risk perception and control over disease development) surveys at baseline, 3, and 12 months. 391 subjects enrolled of which 312 completed the study. Behavioral and clinical outcomes did not differ across FHH or genetic risk but cognitive precursors did. Higher FHH risk was associated with a stronger perceived T2D risk (pKendall < 0.001) and with a perception of “serious” risk (pKendall < 0.001). Genetic risk did not influence risk perception, but was correlated with an increase in perception of “serious” risk for moderate (pKendall = 0.04) and average FHH risk subjects (pKendall = 0.01), though not for the high FHH risk group. Perceived control over T2D risk was high and not affected by FHH or genetic risk. FHH appears to have a strong impact on cognitive precursors of behavior change, suggesting it could be leveraged to enhance risk counseling, particularly when lifestyle change is desirable. Genetic risk was able to alter perceptions about the seriousness of T2D risk in those with moderate and average FHH risk, suggesting that FHH could be used to selectively identify individuals who may benefit from genetic risk testing.

Keywords

Genetic testing Risk stratification Family history Primary prevention 

References

  1. Annis, A. M., Caulder, M. S., Cook, M. L., & Duquette, D. (2005). Family history, diabetes, and other demographic and risk factors among participants of the National Health and nutrition examination survey 1999-2002. Preventing Chronic Disease, 2(2), A19.PubMedPubMedCentralGoogle Scholar
  2. Avis, N. E., Smith, K. W., & McKinlay, J. B. (1989). Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed? American Journal of Public Health, 79(12), 1608–1612.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health psychology: official journal of the Division of Health Psychology. American Psychological Association, 26(2), 136–145.Google Scholar
  4. Cho, A. H., Killeya-Jones, L. A., O’Daniel, J. M., Kawamoto, K., Gallagher, P., Haga, S., et al. (2012). Effect of genetic testing for risk of type 2 diabetes mellitus on health behaviors and outcomes: study rationale, development and design. BMC Health Services Research, 12, 16.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Claassen, L., Henneman, L., Janssens, A. C., Wijdenes-Pijl, M., Qureshi, N., Walter, F. M., et al. (2010). Using family history information to promote healthy lifestyles and prevent diseases; a discussion of the evidence. BMC Public Health, 10, 248.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Codori, A. M., Petersen, G. M., Miglioretti, D. L., & Boyd, P. (2001). Health beliefs and endoscopic screening for colorectal cancer: potential for cancer prevention. Preventive Medicine, 33(2 Pt 1), 128–136.PubMedGoogle Scholar
  7. Cornelis, M. C., Qi, L., Zhang, C., Kraft, P., Manson, J., Cai, T., et al. (2009). Joint effects of common genetic variants on the risk for type 2 diabetes in U.S. men and women of European ancestry. Annals of Internal Medicine, 150(8), 541–550.CrossRefPubMedPubMedCentralGoogle Scholar
  8. de Miguel-Yanes, J. M., Shrader, P., Pencina, M. J., Fox, C. S., Manning, A. K., Grant, R. W., et al. (2011). Genetic risk reclassification for type 2 diabetes by age below or above 50 years using 40 type 2 diabetes risk single nucleotide polymorphisms. Diabetes Care, 34(1), 121–125.CrossRefPubMedGoogle Scholar
  9. Diabetes Genetics Initiative of Broad Institute of H, Mit, LU, Novartis Institutes of BioMedical R, Saxena, R., Voight, B. F., Lyssenko, V., Burtt, N. P., et al. (2007). Genome-wide association analysis identifies loci for type 2 diabetes and triglyceride levels. Science, 316(5829), 1331–1336.CrossRefGoogle Scholar
  10. Diabetes Prevention Program Research G, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM (2009). 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. Lancet, 374(9702), 1677–1686.CrossRefGoogle Scholar
  11. Edwards, A., Hood, K., Matthews, E., Russell, D., Russell, I., Barker, J., et al. (2000). The effectiveness of one-to-one risk communication interventions in health care: a systematic review. Medical Decision Making: An International Journal of the Society for Medical Decision Making, 20(3), 290–297.CrossRefGoogle Scholar
  12. Floyd, D. L., Prentice-Dunn, S., & Rogers, R. W. (2000). A meta-analysis of research on protection motivation theory. Journal of Applied Social Psychology, 30(2), 407–429.CrossRefGoogle Scholar
  13. Grant, R. W., O’Brien, K. E., Waxler, J. L., Vassy, J. L., Delahanty, L. M., Bissett, L. G., et al. (2013). Personalized genetic risk counseling to motivate diabetes prevention: a randomized trial. Diabetes Care, 36(1), 13–19.CrossRefPubMedGoogle Scholar
  14. Hariri, S., Yoon, P. W., Qureshi, N., Valdez, R., Scheuner, M. T., & Khoury, M. J. (2006). Family history of type 2 diabetes: a population-based screening tool for prevention? Genetics in Medicine: Official Journal of the American College of Medical Genetics, 8(2), 102–108.CrossRefGoogle Scholar
  15. Heideman, W. H., Middelkoop, B. J., Nierkens, V., Stronks, K., Verhoeff, A. P., van Esch, S. C., et al. (2011). Changing the odds. What do we learn from prevention studies targeted at people with a positive family history of type 2 diabetes? Primary Care Diabetes, 5(4), 215–221.CrossRefPubMedGoogle Scholar
  16. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research G (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6), 393–403.CrossRefGoogle Scholar
  17. Kreuter, M. W., & Strecher, V. J. (1996). Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Health Education Research, 11(1), 97–105.CrossRefPubMedGoogle Scholar
  18. Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992). Illness cognition - using common-sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16(2), 143–163.CrossRefGoogle Scholar
  19. Marteau, T. M., & Weinman, J. (2006). Self-regulation and the behavioural response to DNA risk information: a theoretical analysis and framework for future research. Social Science & Medicine, 62(6), 1360–1368.CrossRefGoogle Scholar
  20. Marteau, T. M., French, D. P., Griffin, S. J., Prevost, A. T., Sutton, S., Watkinson, C., et al. (2010). Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours. The Cochrane Database of Systematic Reviews, 10, CD007275.Google Scholar
  21. McVay MA, Beadles C, Wu RR, Grubber JM, Coffman CJ, Yancy WS, Jr., Reiner IL, Voils CI. (2015) Effects of genetic risk counseling for diabetes on known predictors of health behavior: Secondary analysis of a randomized controlled trial. Patient Education and Counseling, 98(12), 1600–1612.Google Scholar
  22. Murabito, J. M., Evans, J. C., Larson, M. G., Kreger, B. E., Splansky, G. L., Freund, K. M., et al. (2001). Family breast cancer history and mammography: Framingham offspring study. American Journal of Epidemiology, 154(10), 916–923.CrossRefPubMedGoogle Scholar
  23. Pijl, M., Timmermans, D. R., Claassen, L., Janssens, A. C., Nijpels, G., Dekker, J. M., et al. (2009). Impact of communicating familial risk of diabetes on illness perceptions and self-reported behavioral outcomes: a randomized controlled trial. Diabetes Care, 32(4), 597–599.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Scott, L. J., Mohlke, K. L., Bonnycastle, L. L., Willer, C. J., Li, Y., Duren, W. L., et al. (2007). A genome-wide association study of type 2 diabetes in Finns detects multiple susceptibility variants. Science, 316(5829), 1341–1345.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Soler, R. E., Leeks, K. D., Razi, S., Hopkins, D. P., Griffith, M., Aten, A., et al. (2010). A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback. American Journal of Preventive Medicine, 38(2 Suppl), S237–S262.CrossRefPubMedGoogle Scholar
  26. Tong, Y., Lin, Y., Zhang, Y., Yang, J., Zhang, Y., Liu, H., et al. (2009). Association between TCF7L2 gene polymorphisms and susceptibility to type 2 diabetes mellitus: a large human genome epidemiology (HuGE) review and meta-analysis. BMC Medical Genetics, 10, 15.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study G (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England Journal of Medicine, 344(18), 1343–1350.CrossRefGoogle Scholar
  28. Voils, C. I., Coffman, C. J., Grubber, J. M., Edelman, D., Sadeghpour, A., Maciejewski, M. L., et al. (2015). Does type 2 diabetes genetic testing and counseling reduce modifiable risk factors? A randomized controlled trial of veterans. Journal of General Internal Medicine, 30(11), 1591–1598.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Weinman, J., Petrie, K. J., Moss-morris, R., & Horne, R. (1996). The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychology & Health, 11(3), 431–445.CrossRefGoogle Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2016

Authors and Affiliations

  • R. Ryanne Wu
    • 1
    • 2
  • Rachel A. Myers
    • 1
  • Elizabeth R. Hauser
    • 2
    • 3
    • 4
  • Allison Vorderstrasse
    • 1
    • 5
  • Alex Cho
    • 1
    • 2
  • Geoffrey S. Ginsburg
    • 1
    • 2
    • 6
  • Lori A. Orlando
    • 1
    • 2
  1. 1.Center for Applied Genomics and Precision MedicineDuke UniversityDurhamUSA
  2. 2.Department of MedicineDuke UniversityDurhamUSA
  3. 3.Molecular Physiology InstituteDuke UniversityDurhamUSA
  4. 4.Cooperative Studies Program Epidemiology CenterVAMC, DurhamDurhamUSA
  5. 5.School of NursingDuke UniversityDurhamUSA
  6. 6.Department of PathologyDuke UniversityDurhamUSA

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