Prediabetes Identification and Diabetes Prevention Program Referral

Abstract

Background: Diabetes is a common chronic disease and can lead to comorbidities such as coronary artery disease, stroke, hypertension, peripheral vascular disease, nephropathy, neuropathy, and retinopathy. Prediabetes is an asymptomatic disease that precedes type 2 diabetes and affects 84 million Americans. Participating in a structured diabetes prevention program (DPP) incorporating education on healthy diet, physical activity of at least 150 minutes per week, and weight loss of at least 5-7% can prevent or prolong a diabetes diagnosis.

Local Problem: A suburban primary care clinic was inconsistently identifying patients with prediabetes and not referring them to an evidence-based diabetes prevention program. The purpose of this project was to implement and evaluate a quality improvement project incorporating prediabetes identification and referral to a DPP at the primary care clinic.

Interventions: At the primary care clinic, adults identified with prediabetes who met inclusion criteria were referred to an evidence-based diabetes prevention program approved by the Center for Disease Control and Prevention (CDC). Criteria included being 18 years of age or older, having lab values in the prediabetes range (HgA1c 5.7-6.4%), and did not have a previous diabetes diagnosis. Medical assistants were educated on the prediabetes identification and referral process for the first two weeks of the project. Implementation began at week three and continued through week 14 with the intention of continuing the program after the project completed.

Results: A total of 764 patients were seen in the clinic over a 12-week timeframe. Of the patients who were seen, 335 underwent laboratory analysis of glycated hemoglobin (HbA1c) with 130 of those results between 5.7-6.4%. Considering diabetes prevention program inclusion criteria, 44 patients were removed for having a previous diabetic diagnosis or a BMI < 24 (<22 if Asian). Of the remaining 76 patients, 35 were identified, based on chart review, as having an “elevated HbA1c” or prediabetes. Four of those patients were notified of the DPP and referred to the program.

Conclusions: Overall, office staff was willing to learn how to identify prediabetic patients and refer them to a DPP. Patients identified with prediabetes and notified of the DPP were willing to be referred. Limitations of implementation were identified and if altered could improve the volume of patients referred to a DPP. Sustaining the prediabetes identification and referral process at this clinic could help to detect additional patients with prediabetes and help to prevent or prolong a diabetes diagnosis.