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No patients with prediabetes referred to prevention program
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None of the more than 1,400 patients with prediabetes were formally referred to the CDC’s National Diabetes Prevention Program, according to findings recently published in the Journal of the American Board of Family Medicine.
“The fact that there is a highly effective (better than the effectiveness of most medicines!) lifestyle intervention — the National Diabetes Prevention Program — to prevent progression to type 2 diabetes is wonderful,” James W. Keck, MD, MPH, a physician within the department of family and community medicine at the University of Kentucky, told Healio Primary Care. “However, this program is sorely underutilized. With one in three adults meeting the definition of prediabetes, there is much work to do to raise awareness of prediabetes and the diabetes prevention program.”
Researchers analyzed the electronic health records of 5,360 adult patients at an academic family medicine clinic who met the U.S. Preventive Services Task Force’s guidelines for diabetes screening to determine whether they received prediabetes screening, diagnosis and treatment. Keck and colleagues also reviewed 31 surveys from clinicians from the same clinic about their prediabetes attitudes, knowledge and practices.
They found that:
- 4,068 (76%) patients received a hemoglobin A1c test, of whom 1,437 (35%) patients had a result in the prediabetes range. Of these, 729 (51%) had the prediabetes diagnosis in their EHR.
- Of the patients with prediabetes, none were referred to a diabetes prevention program.
- Patients with prediabetes who received point-of-care A1c testing instead of laboratory testing were 4.7 times more likely to get a metformin prescription.
- 20 (65%) of the clinicians believed screening for prediabetes to be important.
- 29 (97%) of the clinicians thought prediabetes was an “important health issue.”
- All clinicians felt diagnosis was important for prediabetes management.
Keck discussed the barriers that probably led to the low numbers of patients referred to the National Diabetes Prevention Program.
“Awareness of the program is clearly one. Insurance coverage is another important factor — more and more insurers are recognizing the wisdom of paying for the diabetes prevention program, but coverage is still low. This is changing, thankfully, with more private insurers covering the diabetes prevention program and Medicare coming on board last year. Another barrier is perceptions — both from patients and clinicians — that the diabetes prevention program is not likely to work or be a good fit for a patient. Lastly, the lack of a streamlined (ideally electronic) referral process was a big barrier,” he said in the interview.
Keck also discussed ways to overcome some of these obstacles.
“We implemented an electronic referral in our electronic medical record. We educated clinicians about the importance of prediabetes care and the effectiveness of the diabetes prevention program. We shared what we learned from our patient focus groups — that patients want explicit recommendations from their clinicians on what to do to prevent diabetes. For health systems that don’t have a diabetes prevention program provider, they need to cultivate relationships with organizations to offer the diabetes prevention program or consider offering it themselves,” he said, adding that the AMA and CDC websites have prediabetes kits to help health care providers.
In a related editorial, Arch G. Mainous, III, PhD, and Desmond A. Schatz, MD, both of the University of Florida, justified the importance of referring patients with prediabetes to a prevention program.
“Data indicate that one in four health care dollars in 2017 were spent on caring for patients with diagnosed diabetes. Moreover, patients with diagnosed diabetes have health care costs 2.3 times higher than patients without diabetes,” they wrote.
“Yet, between 75% and 90% of patients with prediabetes — the group without diabetes but at high risk for developing it — are not formally identified and do not know that they have it. This is a missed opportunity for disease prevention [which] is a hallmark of an effective health care system ... and is necessary so that we are not looking at a future where a primary purpose of the health care system is managing millions of patients with diabetes that could have been prevented,” Mainous and Schatz added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.