Introduction and Objective: Effective diabetes prevention strategies exist, yet sustained patient engagement in preventive pathways within routine primary care remains challenging. In 2022, Maccabi Healthcare Services implemented a prediabetes program in Nazareth and Nof HaGalil, two cities in Northern Israel, employing a shared decision-making model. Patients chose between physician-led care and physician care combined with intensive dietary counseling. We evaluated the effectiveness of these pathways in preventing progression to diabetes compared with usual care.Methods: Of 402 eligible adults, 329 were recruited; 88 chose the physician-led arm (2 physician visits) and 241 chose the intensive intervention (2 physician visits and 4 dietitian visits within 6 months). Intervention participants were matched 1:2 by year of birth (±5 years), age at diagnosis (±2 years), and sex to usual-care controls from the same cities (n=658). Baseline was defined as the date of enrollment (or equivalent index date for controls). Follow-up concluded at diabetes onset or November 30, 2025. Cumulative incidence of diabetes was compared using Cox regression to calculate hazard ratios (HR).Results: The mean age was 55.4±11.4 years for the intervention group and 57.0±11.1 years for the control group (P=0.02), and 54.7% were women. Baseline characteristics for intervention vs. control groups were: BMI (30.7±4.6 vs. 30.3±10.2 kg/m², P=0.009), fasting glucose (102.5±10.7 vs. 98.9±11.0 mg/dL, P<0.001), and HbA1c (5.8±0.3% vs. 5.7±0.3%, P<0.001). Metformin was initiated in 15.8% of the intervention group and 5.3% of the control group (P=0.001). Over a mean follow-up of 2.6 ± 0.6 years, diabetes developed in 1 participant (0.3%) in the intervention group versus 20 in the control group (3.0%), corresponding to an HR of 0.10 (95% CI 0.01-0.70).Conclusion: A personalized, preference-sensitive intervention delivered in primary care reduced the relative risk of progression from prediabetes to diabetes by 90%. Findings support shared decision-making in diabetes prevention.
A. Nakhleh: None. G. Beeri: None. A. Hurvits: None. S. Spitzer: None. N. Shehadeh: None.
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