Communicating risk of diabetes to patients results in lower incidence at 1- and 3-year follow-up and improved preventive intervention
Authors: Bailey-Davis Lisa , Wood G. Craig , McCabe Carolyn F. , Cook Adam , Rolston David D. , Seiler Christopher , Still Christopher D. 
Published: June 2022

Objective

One-third of American adults are estimated to have prediabetes but the vast majority are unaware. Accordingly, persons with prediabetes are equally unaware of their personal susceptibility of developing type 2 diabetes and the impact of weight loss on reducing the risk of progression. The primary aim of this study was to demonstrate that raising awareness of present risk, risk reduction, and offering available, accessible preventive interventions would result in fewer incidences of type 2 diabetes at 1- and 3-year follow-up periods. Secondary aims included clinician use of a novel diabetes risk calculator in primary care indicated by the proportion of patients being offered a preventive intervention.

Methods

In this single-arm study, persons with prediabetes from three primary care sites received a letter that communicated their personalized risk of progression to diabetes within three years; estimated risk reduction with 5, 10, 15% weight loss, reported in pounds, representing data illustrated in the diabetes risk calculator; and offered a choice of five free, 6-month, programs. Progression to type 2 diabetes was evaluated at 1- and 3-year follow-up periods using electronic health record data. Comparisons are made between the active participants and the non-respondent group. The diabetes risk calculator was implemented in 53 primary clinics in July 2020 and viewable in the electronic health record of persons with prediabetes without the need for clinician action. Electronic health record data were used to evaluate the rate of clinicians offering or referring persons with prediabetes to a preventive intervention—these rates of referral were compared between two phases (pre-implementation: 8/2019-2/2020; early implementation: 8/2020-2/2021).

Results

Persons with prediabetes (N=328) received letters and n=83 responded to the invitation to choose a preventive intervention (treatment). Follow-up data were available for n=55 treatment and n=169 non-respondents at 1- and 3-years. At 1-year follow-up, 2% of treatment and 20% of non-respondents developed type 2 diabetes (p<0.0001) and at 3-year follow-up, 25% of treatment and 42% of non-respondents developed diabetes (p=0.038). In the early implementation phase, N=8,771 persons had prediabetes, 0.4% received care, and 10.7% received a referral whereas in the pre-implementation phase, N=9,638 persons had prediabetes, 0.3% received care (p=0.088), and 9.7% were referred (p=0.029).

Conclusion

Progression to type 2 diabetes was halted at 1- and 3-year follow-up for a significantly higher proportion of persons who received diabetes risk calculator results and initiated a preventive intervention compared to those who did not. In the early implementation phase, clinicians referred a higher proportion of persons with prediabetes to preventive intervention when presented with diabetes risk calculator results as compared the pre-implementation period.