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HealthJune 17, 2021

Are healthcare systems adhering to diabetes prevention guidelines? New study measures compliance

By: Sarah Handzel, BSN, RN
The Centers for Disease Control and Prevention (CDC) estimate that almost 88 million American adults, or more than one in three people over the age of 18, have prediabetes.

But as many as 84% of these individuals aren’t aware of their condition. Left untreated, prediabetes may easily develop into type 2 diabetes mellitus, costing billions each year in diagnostic, treatment, and lost productivity costs.

Currently, the U.S. Preventative Services Task Force (USPSTF) recommends screening all asymptomatic, overweight or obese adults aged 35 to 70 for prediabetes and type 2 diabetes. Additionally, adults with abnormal glucose values should be immediately referred to intensive behavioral health counseling to help stop disease progression.3

Using clinical data from two healthcare systems, the authors of a new study in the Journal for Healthcare Quality sought to measure adherence to USPSTF guidelines. They hope the information gathered in the study serves as a foundation for future research that helps improve fidelity to evidence-based practices for prediabetes.

Participating clinics and patient populations

Data for the study was collected from two healthcare systems: the first was a community-based, nonprofit, integrated healthcare delivery system providing more than half of all healthcare services in one state. The second was an academic healthcare system with affiliated health plan and community-based outpatient clinics in the same state. In total, these two systems deliver 85% of all healthcare in the state.

The study authors collected data from anyone age 18 or older who received care from either healthcare system between 2016 and 2018. Eligible study participants were between the age of 40 and 70 with a body mass index (BMI) of greater than or equal to 25 kg/m2. Additionally, each participant had at least one outpatient encounter during the study period.

Prediabetes screening was defined as a person having at least one screening test, either a HbA1C or fasting plasma glucose, during the study period. Participation in an intensive behavioral counseling program was defined by those who engaged in a CDC-recognized diabetes prevention program, generally accepted as the most universal form of intensive behavioral counseling in America.

Study results show room for improvement

In total, the study included information gathered from 581,900 patients who were identified as having an outpatient encounter during the study period. 79.4% of these individuals were served at the community-based healthcare system, while 20.6% were cared for at the academic healthcare system. Of this patient population, 31.5% were eligible for diabetes screening and 7.7% had confirmed prediabetes.

According to the data, the median percentage of patients who received diabetes screening was only 45.7%. Only 0.52% with prediabetes participated in a CDC-recognized diabetes prevention program. However, when other community-based interventions were included, the median participation jumped to 12.7%.

The authors acknowledge that, since information from only two healthcare systems was included in this study, coding differences and other factors may influence data for screening and participation in diabetes prevention program services. For example, there was no measure of any patient’s readiness to engage in prediabetes screening or intervention, or whether insurance would cover either.

While participation rates for CDC-recognized diabetes prevention programs was very low, the authors note that rates were higher in clinics that also offered less intensive, evidence-based prediabetes interventions. This may suggest that patients prefer less intense interventions, which could, in turn, be used to gradually guide patients to higher-intensity programs.

As less than half of the study participants were screened for prediabetes, and most did not participate in any behavioral counseling, it appears as though the two healthcare systems in question have not met USPSTF guidelines. The authors suggest that systemic implementation strategies be developed to help improve screening and participation in interventions designed to reverse prediabetes trends.

Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
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