Prediabetes: Translating Practical Interventions for the Treatment of Primary Care Patients
Creators: name: Brunisholz, Kimberly D.
Publisher: name: University of Utah
Year: 2016
Subjects: Prediabetic state - Prevention

description: Several studies have demonstrated an association between prediabetes (preDM) and the incidence of Type II Diabetes Mellitus (T2DM). Many preventable factors can contribute to this association, namely behavioral and environmental conditions that lead to physiological changes and symptomology. Earlier identification of disease through combining common laboratory studies that demonstrate an elevated fasting glucose may be one mechanism to identify the vast majority of patients who are unaware of their preDM condition. Also, it has been widely demonstrated that T2DM can be effectively prevented or delayed with interventions geared towards weight management, physical activity, goal setting, and stress management. However, it is not entirely known whether education provided within a healthcare delivery system is effective in supporting patients to reach a 5% weight loss while reducing their overall incidence of T2DM disease. Furthermore, study is needed to evaluate such health interventions beyond effectiveness, to better identify effect and transferability through measuring the reach, adoption, and implementation. The objective of this dissertation was to determine: (a) the risk of T2DM among patients with confirmed and unconfirmed preDM relative to an at-risk group; (b) the association of a 5% weight loss with participation in the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP); and, subsequently, (c) the reach, effectiveness, adoption, and implementation of the IH DPP intervention. The IH Enterprise Data Warehouse was utilized to evaluate these objectives. Patients with unconfirmed preDM iv (HR 1.74; CI 1.59, 1.91; p&lt;0.0001) and confirmed preDM (HR 2.77; CI 2.38, 3.23; p&lt;0.0001) were more likely to develop T2DM when compared to at-risk patients. DPP participants were more likely to achieve a 5% weight loss within 6 months (OR 1.72; 95% CI 1.29, 2.34; p&lt;0.001) and less likely to have incident T2DM (OR 0.45; 95% CI 0.24, 0.84; p=0.012) when compared to the no-DPP group. Lastly, DPP-based lifestyle interventions deployed within IH's delivery system demonstrated moderate effectiveness in the short term, yet the proportion of patients (8%) who enrolled was low. Broad adoption across regions by providers and leadership revealed organizational buy-in (194 providers at 53 clinics referred patients), while demonstrating that much of the clinical effect was seen when patients participated in interventions that were far less resource intensive (only 2.3 DPP counseling encounters on average). In conclusion, confirmed and unconfirmed preDM was associated with T2DM, however when patients participated in a DPP-based intervention, there was significant weight loss and reduction in T2DM incidence. Finally, the IH DPP demonstrated encouraging potential when evaluating organizational adoption and short-term effectiveness, yet may benefit from leveraging technology to scale these established interventions for those at risk for disease.