START Diabetes Prevention: A Multi-Level Strategy for Primary Care Clinics
Abstract
BACKGROUND: Prediabetes, a high-risk state for developing diabetes, affects more than 1 in 3 adults nationally. However, <5% of people with prediabetes are receiving any treatment for prediabetes. Prior intervention studies for increasing prediabetes treatment uptake have largely focused on individual barriers with few multi-level interventions that address clinician- and system-level barriers.
OBJECTIVE: To measure the effectiveness of a multi-level intervention on uptake of prediabetes treatment in a primary care clinic.
DESIGN: Pragmatic study of the START (Screen, Test, Act, Refer and Treat) Diabetes Prevention intervention.
PARTICIPANTS: The START Diabetes Prevention intervention was implemented in a suburban primary care clinic outside of Baltimore compared to a control clinic in the same area over a 12-month period.
INTERVENTION: START Diabetes Prevention intervention included a structured workflow, shared decision-making resources and electronic health record clinical decision support tools.
MAIN MEASURES: Uptake of prediabetes treatment, defined as Diabetes Prevention Program referral, metformin prescription and/or medical nutrition referral within 30 days of any PCC visit.
KEY RESULTS: We demonstrated greater uptake of preventive treatment among patients with prediabetes in the intervention clinic vs. control clinic receiving usual care (11.6% vs. 6.7%, p<0.001). More patients in the intervention vs. control clinic reported their PCC discussed prediabetes with them…
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