Clinical Care Among Individuals with Prediabetes in Primary Care: a Retrospective Cohort Study

Abstract

BACKGROUND:The incidence of diabetes in the general US population (6.7 per 1000 adults in 2018) has not changed significantly since 2000, suggesting that individuals with prediabetes are not connecting to evidence-based interventions. OBJECTIVE: We sought to describe the clinical care of individuals with prediabetes, determine patient factors associated with this care, and evaluate risk for diabetes development. DESIGN: Retrospective cohort study using linked claims and electronic health record data. PARTICIPANTS: We created a cohort of adults with prediabetes based on laboratory measures. We excluded patients with a prior history of diabetes, pregnancy in prior 6 months, or recent steroid use. MAIN MEASURES: We measured ordering and completion of clinical services targeting prediabetes management and diabetes incidence within 12 months following cohort entry. We tested the strength of the association between individuals' characteristics and outcomes of interest using bivariate and multiple logistic regression. RESULTS: Our cohort included 3888 patients with a laboratory diagnosis of prediabetes (incident or prevalent prediabetes). Within 12 months, 63.4% had repeat glycemic testing, yet only 10.4% had coded diagnoses of prediabetes, 1.0% were referred for nutrition services, and 5.4% were prescribed metformin. Most patients completed labs and nutrition visits when referred and filled metformin when prescribed. Individuals with a higher glycemic level or BMI were more likely to receive prediabetes clinical care. Six percent of individuals developed diabetes within 12 months of cohort entry and had higher glycemic levels and BMI ≥ 30 kg/m 2 . In the adjusted model, Black individuals had 1.4 times higher odds of developing diabetes than White individuals. CONCLUSIONS: Rates of prediabetes clinical care activities are low and have not improved. Strategies are urgently needed to improve prediabetes care delivery thereby preventing or delaying incident diabetes.

Cumulative BMI and incident prediabetes over 30 years of follow‐up: The CARDIA study

“…This is complicated by the practical application of lifestyle advice in those with prediabetes. A recent clinical care study found that among 3888 patients with a laboratory diagnosis of prediabetes, 63.4% had glycemic testing within 12 months of diagnosis, but only 1.0% were provided with a nutrition counseling referral, and only 5.4% were prescribed metformin [21].…”

Progression from prediabetes to type 2 diabetes mellitus in adolescents: a real world experience

“…Adult data has indicated that prediabetes is under-coded in claims data. One study of 3,888 adults with laboratory evidence of prediabetes showed that only 10.4% had a coded diagnosis of prediabetes within the following 12 months ( 28 ). Given the known high attrition rate for pediatric patients with T2D, this study classified subjects with a single HbA1C ≥ 6.5% with a diagnosis of T2D ( 29 ).…”

Applying Design-Thinking Principles to Practice-Based Pharmacy Research

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