Genetic counseling as a tool for type 2 diabetes prevention: a genetic counseling framework for common polygenetic disorders

Abstract

Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT00849563 NCT01034319 NCT01060540 NCT01186354.

Figures

Fig. 1

The genetic counseling intervention. The counseling intervention developed for the GC/LC Study included both an educational component and a motivational message. The motivational message consisted of two parts: an invariant message emphasizing lifestyle change and a second message tailored to the individual’s genetic risk result

Fig. 2

Counseling figures depicting environmental & genetic risk factors for T2D. This set of pictures illustrated that both genetic and environmental factors contributes to T2D risk. Panel 2a depicted the relative proportions of genetic and lifestyle risk, while Panel 2b demonstrated distinctions between risks under individual control versus those not under individual control

Fig. 3

Risk for developing diabetes in the next 3 years. This set of figures compared a baseline risk for T2D (a) with a risk adjusted according to the individual’s genetic test result (b and c). We counseled an adjusted risk of 17% (b) for those subjects in the “higher genetic risk” group, while a 9% risk (c) was provided for those subjects in the “lower genetic risk” group