Implementation of a prediabetes identification algorithm for overweight and obese Veterans

Abstract

Abstract-Type 2 diabetes prevention is an important national goal for the Veterans Health Administration (VHA): one in four Veterans has diabetes. We implemented a prediabetes identification algorithm to estimate prediabetes prevalence among overweight and obese Veterans at Department of Veterans Affairs (VA) medical centers (VAMCs) in preparation for the launch of a pragmatic study of Diabetes Prevention Program (DPP) delivery to Veterans with prediabetes. This project was embedded within the VA DPP Clinical Demonstration Project conducted from 2012 to 2015. Veterans who attended orientation sessions for an established VHA weight-loss program (MOVE!) were recruited from VAMCs with geographically and racially diverse populations using existing referral processes. Each site implemented and adapted the prediabetes identification algorithm to best fit its local clinical context. Sites relied on an existing referral process in which a prediabetes identification algorithm was implemented in parallel with existing clinical flow; this approach limited the number of overweight and obese Veterans who were assessed and screened. We evaluated 1,830 patients through chart reviews, interviews, and/or laboratory tests. In this cohort, our estimated prevalence rates for normal glycemic status, prediabetes, and diabetes were 29% (n = 530), 28% (n = 504), and 43% (n = 796), respectively. Implementation of targeted prediabetes identification programs requires careful consideration of how prediabetes assessment and screening will occur.

Results From a Trial of an Online Diabetes Prevention Program Intervention

“…Between September 2013 and June 2014, a total of 1,182 patients were assessed for eligibility and invited to enroll (Figure 1). 20,21 A total of 268 (23%) participants consented to participate. Online DPP participants had a mean age of 60 years (SD=11.3), BMI of 32.6 kg/m 2 (SD=5.5), and HbA1c 6.0% (SD=0.2); 31% were female, 12% were Hispanic and 24% were African American (Table 1).…”

Diabetes Prevention Program Translation in the Veterans Health Administration

“…Between August 2012 and January 2014, a total of 1,830 patients were assessed for eligibility (Figure 1). 26,27 An additional 20 patients were contacted but excluded from analyses because of incomplete screening information. A total of 387 eligible individuals were systematically assigned to VA-DPP ( n =273) or MOVE!…”

“…Although 12-month differences in weight change and HbA1c were not significantly different, participation in VA-DPP was higher and prior work indicated higher satisfaction compared with MOVE!. 25,27 Program differences (Appendix Table 1) included VA-DPP use of closed cohorts, a single coach per cohort, and more sessions during the initial intensive phase of the program. Based on early results, guidance for MOVE!…”

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

“…Despite the “voltage drop” [ 9 ] often seen in outcomes within real-world settings, definitive guideline statements have been disseminated recommending DPP around the world [ 10 – 12 ]. Despite large-scale population-based availability of DPP in some countries (Finland being a notable leader [ 13 ]), within other countries, access to DPP is limited, in part because of the expense, lack of reimbursement by insurance or funding entities, and challenges of effectively implementing DPP across diverse uncontrolled settings and populations [ 14 – 17 ]. Within the USA, interest in implementing DPP is increasing because the US Centers of Medicare and Medicaid Services (CMS) plans to reimburse participation expenses for eligible individuals starting in 2018 [ 18 ]; over 1000 programs were listed in the Centers for Disease Control and Prevention (CDC) registry of certified programs [ 19 ] as of November 2016 compared to 500 in May 2014 [ 12 ].…”