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Fewer than 15% of patients undergo diabetes screening
The rate of diabetes screening in the U.S. rose from 2012 to 2015 but still remained below 15%, according to findings recently published in the Journal of the American Board of Family Medicine.
The same study also concluded that clinicians mostly prescribed lifestyle changes, such as exercise and a healthy diet, and occasionally metformin to prevent diabetes.
“Treatment of [diabetes mellitus] was estimated to cost $237 billion in direct medical costs and approximately $90 billion due to lost productivity in 2017,” Kayce M. Shealy, PharmD, associate professor and chair, department of pharmacy practice at Presbyterian College in Clinton, South Carolina and colleagues wrote. “Identifying patients at risk for developing diabetes mellitus and using effective interventions to prevent diabetes mellitus in those at risk may lead to reduced health care spending by avoiding the costs associated with treating overt diabetes mellitus.”
Researchers utilized National Ambulatory Medical Care Survey data to review details of 105,721 office visits of patients without diabetes from 2012 to 2015. All patients aged 45 years and older were included; those younger than 45 years were only included if their BMI was higher than 25 kg/m2 and they had one additional risk factor for diabetes.
They found that the diabetes screening prevalence increased from 10% in 2012 to 13.4% in 2015. In addition, clinicians generally prescribed lifestyle changes modifications, like a healthy diet and exercise, to forestall diabetes. Metformin was the most frequently prescribed diabetes prevention medication.
Shealy suggested ways primary care clinicians can improve diabetes screening rates with Healio Primary Care.
“Encouraging patients to complete the American Diabetes Association’s risk assessment at home prior to coming in or even while waiting to be seen may be helpful. Having these results, in conjunction with a thorough patient history on file, accessible to the provider during the visit itself is key,” she said.
“Utilizing other resources — the CDC’s Diabetes Prevention Program, the Prevent Diabetes STAT toolkit from the AMA, CDC, American Diabetes Association and the Ad Council — as well as other health care personnel like pharmacists, nurses, social workers, nutritionists and community health workers may also be helpful,” Shealy added. – by Janel Miller
For more information:
The American Diabetes Association’s risk assessment is at: http://www.diabetes.org/assets/pdfs/at-risk/ada-risk-test-generic.pdf
The CDC National Diabetes Prevention Program is at: https://www.cdc.gov/diabetes/prevention/index.html
The Prevent Diabetes STAT toolkit is at: https://preventdiabetesstat.org/toolkit.html
Disclosures: The authors report no relevant financial disclosures.
Perspective
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I am not surprised by the results of this study. Utilizing the National Ambulatory Medical Care Survey data, although accessible and reliable, is a national sample survey of previous office-based visits. This survey was not specifically designed for use in this study.
As Shealy et al reported, prevalence of prediabetes is highest in the older population although fewer patients in this age category received screening. This is most likely due to lack of coverage for this important screening test by Medicare. We would recommend that Medicare provide coverage for this important screening.
At the Academic Health Care centers here at New York Institute of Technology College of Osteopathic Medicine, we are vigilant in providing both screening for diabetes as well as treatment for prediabetes, as per American Diabetes Association guidelines. As an academic institution, our physicians are current on evidence-based medicine guidelines to ensure our medical students are receiving the most up to date medical education. This aids to prepare them for success during their clinical education years. Our institutions are not low in their screening and treatment rates.
We utilize our electronic medical record system to provide us with practice alerts to ensure we are providing the appropriate screenings to our patient population. Additionally, HbA1c is one of our two outcome measures for CMS Merit-based Incentive Payment System (MIPS) reporting, and our electronic medical record MIPS dashboard provides us with real-time data on our performance.
Prediabetes and diabetes screenings may be low due to patients potentially opting for lifestyle management first to avoid medication. Short-term follow-up would be advised if the patients chose this route, to monitor for disease progression vs. regression. It is possible that physicians are counseling on lifestyle management; however, their EMR documentation may not be “captured” if the information is not documented in a “structured field” within the electronic medical record.
Primary care physicians looking to increase treatment and screening rates should continue to stay current with evidence-based guidelines. The ADA may consider offering free webinars to physicians, once new recommendations are released. PCPs should also continue to serve as the patients’ advocate by educating their patients on effective lifestyle changes to reduce their risk factors for disease progression. These clinicians should also consider working with their electronic medical record vendor to ensure they are maximizing their electronic medical record’s functionality to capture this important data.
New York Institute of Technology College of Osteopathic Medicine
New York Institute of Technology Academic Health Care Center