The clinical application of genetic testing in type 2 diabetes: a patient and physician survey.
OBJECTIVE
Advances in type 2 diabetes genetics have raised hopes that genetic testing will improve disease prediction, prevention and treatment. Little is known about current physician and patient views regarding type 2 diabetes genetic testing. We hypothesised that physician and patient views would differ regarding the impact of genetic testing on motivation and adherence.


METHODS
We surveyed a nationally representative sample of US primary care physicians and endocrinologists (n = 304), a random sample of non-diabetic primary care patients (n = 152) and patients enrolled in a diabetes pharmacogenetics study (n = 89).


RESULTS
Physicians and patients favoured genetic testing for diabetes risk prediction (79% of physicians vs 80% of non-diabetic patients would be somewhat/very likely to order/request testing, p = 0.7). More patients than physicians (71% vs 23%, p < 0.01) indicated that a 'high risk' result would be very likely to improve motivation to adopt preventive lifestyle changes. Patients favoured genetic testing to guide therapy (78% of patients vs 48% of physicians very likely to request/recommend testing, p < 0.01) and reported that genetic testing would make them 'much more motivated' to adhere to medications (72% vs 18% of physicians, p < 0.01). Many physicians (39%) would be somewhat/very likely to order genetic testing before published evidence of clinical efficacy.


CONCLUSIONS
Despite the paucity of current data, physicians and patients reported high expectations that genetic testing would improve patient motivation to adopt key behaviours for the prevention or control of type 2 diabetes. This suggests the testable hypothesis that 'genetic' risk information might have greater value to motivate behaviour change compared with standard risk information.
Grant
R W
RW
Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA, 02114, USA. Rgrant@partners.org.|Harvard Medical School, Boston, MA, USA. Rgrant@partners.org.
Hivert
M
M
Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA, 02114, USA.
Pandiscio
J C
JC
Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA, 02114, USA.
Florez
J C
JC
Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA.
Nathan
D M
DM
Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
Meigs
J B
JB
Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.
D003625:Data Collection; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000235:genetics* / Q000517:prevention & control; D005820:Genetic Testing / Q000379:methods*; D015894:Genome, Human; D006801:Humans; D008511:Medicine; D009042:Motivation; D010361:Patients; D010465:Perception; D010597:Pharmacogenetics / Q000379:methods; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D018907:Privacy; D011364:Professional Practice / Q000706:statistics & numerical data; D018570:Risk Assessment