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Krass I, Carter R, Mitchell B, Mohebbi M, Shih STF, Trinder P, Versace VL, Wilson F, Mc Namara KP. Pharmacy diabetes screening trial (PDST): Outcomes of a national clustered RCT comparing three screening methods for undiagnosed type 2 diabetes (T2DM) in community pharmacy. Diabetes Res Clin Pract 2023; 197:110566. [PMID: 36738834 DOI: 10.1016/j.diabres.2023.110566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/04/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS To compare the effectiveness of three pharmacy-based screening methods for type 2 diabetes (T2DM): (1) risk assessment (AUSDRISK) alone (Group A); AUSDRISK followed by a point of care test if AUSDRISK ≥12; either (2) HbA1c (Group B); or (3) small capillary blood glucose test (Group C). METHODS A cluster RCT with a nationally representative sample of Australian pharmacies was implemented with random allocation of eligible pharmacies to Groups A, B or C. GP referral was based on prespecified cut offs. Diagnoses were considered positive if confirmed by a GP, pathology laboratory, or national diabetes register. RESULTS Of the 14,093 people screened in 339 pharmacies, 3059 participants met group-specific referral criteria: 1775 (45%) (Group A); 893 (17%) (Group B); and 391 (8%) (Group C). For the total screened population rates of T2DM diagnoses were significantly higher in Group B (1.5%), compared with Groups A (< 0.8%) and C (< 0.6%) with the odds of detection in Group B compared with Group A (1.8 [1.0;3.0]), and no difference between Groups A and C. CONCLUSIONS In community pharmacy, the most effective method to uncover undiagnosed T2DM was a stepwise approach; initial risk assessment; and if appropriate an HbA1C POC test and referral.
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Affiliation(s)
- Ines Krass
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
| | - Rob Carter
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Bernadette Mitchell
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammadreza Mohebbi
- Biostatistics unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Sophy T F Shih
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia; Kirby Institute, UNSW Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Peta Trinder
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warnambool, Victoria, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warnambool, Victoria, Australia
| | - Frances Wilson
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin P Mc Namara
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia; Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warnambool, Victoria, Australia
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Changes in hyperglycaemia-related testing for prediabetes and type 2 diabetes mellitus management: a prospective, cross-sectional survey of 16 years of general practice data from Australia. BMC PRIMARY CARE 2022; 23:292. [PMID: 36411411 PMCID: PMC9680119 DOI: 10.1186/s12875-022-01896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The rising prevalence of prediabetes increases the population risk of type 2 diabetes mellitus (T2DM), metabolic syndrome and cardiovascular disease. Early identification by General Practitioners (GPs) provides opportunities for lifestyle modifications that can lower these risks. METHODS This study examined 16 years of hyperglycaemia-related testing for patients in Australia aged 13 years or older with, or at risk of a diagnosis of T2DM. The Bettering the Evaluation and Care of Health (BEACH) study is a national cross-sectional survey, with a single-stage, cluster sampling design. Approximately 1,000 GPs were randomly selected annually (2000/01-20,015/16) from across Australia, who each recorded details of 100 consecutive clinical encounters with consenting patients. Point estimates were adjusted for intracluster correlation and GP characteristics. RESULTS Fifteen thousand six hundred seventy nine GPs recorded details of 1,387,190 clinical encounters with patients aged 13 + years. Prediabetes and T2DM were managed at 0.25% (95% CI: 0.24-0.27%) and 3.68% (95% CI: 3.62-3.73%) of encounters respectively. By the end of the study, the proportion of encounters where prediabetes was managed was 2.3 times higher and for T2DM, 1.5 times higher. The proportion of prediabetes (55.9%, 95% CI: 53.9-57.8%) and T2DM (27.3%, 95% CI: 26.7-27.9%) management occasions where one or more hyperglycaemia-related tests were requested were relatively stable. However, differences in the types of tests were observed. For prediabetes, glucose tolerance tests were most common but from 2014/15, requests for HbA1c tests began to increase. For T2DM, HbA1c tests were most common, and requests for one or more glucose tests gradually declined. CONCLUSION The observed 16-year annual trends align with the rising incidence of prediabetes and T2DM. GPs appeared to be strongly influenced by changes to the national insurance scheme and clinical guidelines for hyperglycaemia-related pathology testing. However, some GPs may have been pre-empting policy changes as there was also evidence of 'unendorsed' testing, notably for prediabetes, that warrants further investigation. The increasing proportion of encounters for prediabetes, coupled with a high proportion of management occasions where pathology was requested have substantial resource implications. Calls to lower the risk threshold for prediabetes screening therefore warrant an economic analysis. Ongoing, reliable, up-to-date data is needed to inform clinical practice guidelines and policy in Australia.
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Harcke K, Graue M, Skinner TC, Olsson CB, Stattin NS. Prediabetes screening, treatment, and follow‐up in primary health care: a cross‐sectional survey. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Katri Harcke
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet Huddinge Sweden
- Academic Primary Health Care Centre Stockholm Sweden
| | - Marit Graue
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
| | - Timothy Charles Skinner
- Institute of Psychology University of Copenhagen Copenhagen Denmark
- La Trobe Rural Health School La Trobe University Bendigo Australia
- Australian Centre for Behavioural Research in Diabetes Melbourne Australia
| | - Christina B Olsson
- Academic Primary Health Care Centre Stockholm Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet Huddinge Sweden
| | - Nouha Saleh Stattin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet Huddinge Sweden
- Academic Primary Health Care Centre Stockholm Sweden
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McEwen LN, Hurst TE, Joiner KL, Herman WH. Health Beliefs Associated With Metformin Use Among Insured Adults With Prediabetes. Diabetes Care 2022; 45:2282-2288. [PMID: 35926099 PMCID: PMC9643140 DOI: 10.2337/dc21-2316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To use the framework of the Health Belief Model (HBM) to explore factors associated with metformin use among adults with prediabetes. RESEARCH DESIGN AND METHODS We analyzed survey data from 200 metformin users and 1,277 nonmetformin users with prediabetes identified from a large, insured workforce. All subjects were offered the National Diabetes Prevention Program (DPP) at no out-of-pocket cost. We constructed bivariate and multivariate models to investigate how perceived threat, perceived benefits, self-efficacy, and cues to action impacted metformin use and how demographic, clinical, sociopsychological, and structural variables impacted the associations. RESULTS Adults with prediabetes who used metformin were younger and more likely to be women and to have worse self-rated health and higher BMIs than those with prediabetes who did not use metformin. Those who used metformin were also more likely to be aware of their prediabetes and to have a personal history of gestational diabetes mellitus or a family history of diabetes. After consideration of perceived threat, perceived benefits, self-efficacy, and cues to action, the only independent predictors of metformin use were younger age, female sex, higher BMI, and cues to action, most specifically, a doctor offering metformin therapy. CONCLUSIONS Demographic and clinical factors and cues to action impact the likelihood of metformin use for diabetes prevention. Perceived threat, perceived benefits, and self-efficacy were not independently associated with metformin use. These results highlight the importance of patient-centered primary care and shared decision-making in diabetes prevention. Clinicians should proactively offer metformin to patients with prediabetes to facilitate effective diabetes prevention.
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Affiliation(s)
- Laura N. McEwen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Thomas E. Hurst
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin L. Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
| | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
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Joy AJ, Duckworth L, Scarton L. Type 2 diabetes mellitus screening rates in racial and ethnic minority groups. J Am Assoc Nurse Pract 2022; 34:683-687. [PMID: 35025836 DOI: 10.1097/jxx.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND More than 7 million Americans aged 18 years and older have undiagnosed diabetes. As primary health care moves toward preventative medicine, it is important that diabetes screening deficits are addressed. PURPOSE The purpose of this study was to identify current screening rates among racial and ethnic minorities who are considered at high risk of developing type 2 diabetes mellitus (T2DM). METHODOLOGY Data were collected through an IRB-approved i2b2 database from previously consented patients who had been treated at a large academic health center and outpatient facilities. Patients who were included in this study were those seen in outpatient settings between June 2011 and June 2019, aged 18-39 years at high risk for developing T2DM, defined as those of a racial and ethnic minority background, obese, and with a family history of T2DM. RESULTS Approximately 1,476 ± 3 individuals were identified as high risk, and of those, only 106 ± 3 (13.9%) were screened for T2DM between June 2011 and June 2019. Following the American Diabetes Association guidelines of including body mass index ≥25 kg/m2, approximately 1,263 ± 3 of the original 1,476 patients were identified as overweight with high risk, and of those patients, only 90 ± 3 (13.8%) were screened. CONCLUSIONS Findings indicate that less than 14% of patients at high risk for developing T2DM in their lifetime are being screened. IMPLEMENTATIONS Screening strategies need to be developed and implemented to better identify individuals at high risk of developing T2DM, which may lead to earlier diagnosis, treatment, and decreased disease burden.
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Affiliation(s)
- Alexa J Joy
- University of Florida, College of Nursing, Gainesville, Florida
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Aljehani F, Alsulaiman A, Alqarni A, Almutairi F, Samkari M. Survey of Primary Care Physicians' Screening and Treatment Practices for Prediabetes in Saudi Arabia. Cureus 2022; 14:e21475. [PMID: 35106257 PMCID: PMC8786395 DOI: 10.7759/cureus.21475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background Prediabetes is defined as a condition in which glucose levels do not fulfill the criteria for type 2 diabetes mellitus (T2DM), indicating that the patient is at an increased risk of developing T2DM. The risk of developing T2DM can be decreased by adequately managing prediabetes. This study aimed to assess screening and therapeutic approaches to prediabetes among primary care physicians in Saudi Arabia because there is little contemporary data available on this topic. Methodology A cross-sectional study was performed among primary care physicians in Saudi Arabia. The participants completed a validated online survey questionnaire via Google Forms. Data collected included participants' demographic information, knowledge of T2DM risk factors, and opinions and beliefs on prediabetes management. Results In total, 155 primary care physicians responded to the questionnaire; 51% were male, 18.7% worked in Riyadh City, and 81.3% specialized in family medicine. Most study respondents (71.9%) were residents, and 64.5% worked for the Ministry of Health. Overall, 93.5% of the respondents had completed part of their postgraduate training in Saudi Arabia. Moreover, 27.7% of the respondents were aware of all nine risk factors associated with T2DM. The correct fasting glucose and hemoglobin A1c ranges for the diagnosis of prediabetes were identified by 50% and 43.6% of participants, respectively. Most respondents believed lifestyle modification and metformin to be the most effective management approaches to prediabetes, whereas lack of motivation toward lifestyle changes was deemed to be a major barrier. Conclusions We found significant gaps in primary care physicians' knowledge regarding prediabetes in Saudi Arabia, contributing to underscreening of the condition and undertreatment. Identifying these gaps is essential for focussing educational endeavors toward primary care physicians.
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Affiliation(s)
- Faisal Aljehani
- College of Medicine, Department of Internal Medicine, University of Jeddah, Jeddah, SAU
| | - Abdullah Alsulaiman
- College of Medicine, Department of Internal Medicine, University of Jeddah, Jeddah, SAU
| | - Abdulrahim Alqarni
- College of Medicine, Department of Internal Medicine, University of Jeddah, Jeddah, SAU
| | - Fahad Almutairi
- College of Medicine, Department of Internal Medicine, University of Jeddah, Jeddah, SAU
| | - May Samkari
- Health Program and Chronic Disease Adminstration, Public Health Administration at Saudi Ministry of Health, Jeddah, SAU
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Hulbert LR, Zhang X, Ng BP, Nhim K, Khan T, Cannon MJ. Health Care Providers' Knowledge, Attitudes, and Practices and the Association With Referrals to the National Diabetes Prevention Program Lifestyle Change Program. Am J Health Promot 2021; 36:236-247. [PMID: 34844441 PMCID: PMC8772255 DOI: 10.1177/08901171211044937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To examine how health care providers’ knowledge, attitudes, and practices affect their referrals to the National Diabetes Prevention Program. Design Cross-sectional, self-report data from DocStyles—a web-based survey Setting USA Sample Practicing family practitioners, nurse practitioners, pharmacists, and internists, n = 1,503. Measures Questions regarding health care providers’ knowledge, attitudes, and practices and their referrals to the National Diabetes Prevention Program. Analysis Bivariate and multivariate analyses were used to calculate predictive margins and the average marginal effect. Results Overall, 15.2% of health care providers (n = 1,503) reported making a referral to the National Diabetes Prevention Program. Health care providers were more likely to make referrals if they were familiar with the program (average marginal effect = 36.0%, 95% CI: 29.1%, 42.8%), reported knowledge of its availability (average marginal effect=49.1%, 95% CI: 40.2%, 57.9%), believed it was important to make referrals to the program (average marginal effect = 20.7%, 95% CI: 14.4%, 27.0%), and used electronic health records to manage patients with prediabetes (average marginal effect = 9.1%, 95% CI: 5.4%, 12.7%). Health care providers’ demographic characteristics had little to no association with making referrals. Conclusion Making referrals to the National Diabetes Prevention Program was associated with health care providers’ knowledge of the program and its reported availability, their attitudes, and their use of the electronic health record system to manage patients with prediabetes.
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Affiliation(s)
- LaShonda R Hulbert
- CyberData Technologies, Inc., Herndon, VA, USA.,1242Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Xuanping Zhang
- 1242Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Boon Peng Ng
- College of Nursing and Disability, Aging and Technology Cluster, 16087University of Central Florida, Orlando, FL, USA
| | - Kunthea Nhim
- 1242Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tamkeen Khan
- Improving Health Outcomes, 2445American Medical Association, Chicago, IL, USA
| | - Michael J Cannon
- 1242Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Hurst TE, McEwen LN, Joiner KL, Herman WH. Use of metformin following a population-level intervention to encourage people with pre-diabetes to enroll in the National Diabetes Prevention Program. BMJ Open Diabetes Res Care 2021; 9:9/1/e002468. [PMID: 34645617 PMCID: PMC8515441 DOI: 10.1136/bmjdrc-2021-002468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The National Diabetes Prevention Program (NDPP) and metformin are interventions to slow progression from pre-diabetes to type 2 diabetes. When coverage for the NDPP was offered by a public research university's health insurance plan, proactive strategies were used to combat historically low enrollment. Although not specifically targeted by these strategies, metformin use was higher than expected, leading to this evaluation. RESEARCH DESIGN AND METHODS We used insurance enrollment, claims, pharmacy, and laboratory data for 64 131 adult employees, dependents, and retirees to identify individuals with pre-diabetes and invite them to enroll in the NDPP at no out-of-pocket cost. The characteristics of individuals with pre-diabetes who used metformin before and after their invitation were compared with NDPP enrollees. RESULTS 8131 individuals with pre-diabetes were identified. Of these, 776 (9.5%) enrolled in a NDPP and 802 (9.9%) used metformin. Metformin users were younger, had higher body mass index, were more likely to have comorbidities, and had higher baseline hemoglobin A1c levels than non-users. Timing of metformin use varied with 107 (13%) discontinuing, 426 (53%) continuing, and 269 (34%) initiating metformin use after their NDPP invitation. Of NDPP enrollees, 13 (2%) discontinued, 56 (7%) continued, and 34 (4%) initiated metformin use when they enrolled. CONCLUSIONS Despite no active encouragement, use of metformin was similar to the rate of enrollment in the NDPP. Metformin use was higher for individuals with higher likelihood of responding. With the proven cost-effectiveness of metformin, targeted strategies to increase metformin use in individuals with pre-diabetes who are likely to respond, but not willing to enroll in a lifestyle intervention, are needed.
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Affiliation(s)
- Thomas E Hurst
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura N McEwen
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - William H Herman
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Herman WH, Joiner K, Hurst T, McEwen LN. The Effectiveness of a Proactive, Three-Level Strategy to Identify People With Prediabetes in a Large Workforce With Employer-Sponsored Health Insurance. Diabetes Care 2021; 44:1532-1539. [PMID: 34016617 PMCID: PMC8323177 DOI: 10.2337/dc20-3112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Rates of diagnosis of prediabetes and uptake of the National Diabetes Prevention Program (NDPP) are low. We evaluated a proactive three-level strategy to identify individuals with prediabetes in a population with employer-sponsored health insurance. RESEARCH DESIGN AND METHODS We studied 64,131 insured employees, dependents, and retirees ≥18 years of age without diagnosed diabetes, 19,397 (30%) of whom were estimated to have prediabetes. Individuals with prediabetes were identified by 1) searching claims diagnoses and previously performed HbA1c test results, 2) risk stratifying people 40-64 years of age without diabetes, prediabetes, or documented normal HbA1c to identify individuals at higher risk and encourage them to be tested, and 3) using a media campaign to encourage employees not otherwise targeted to self-screen and, if at higher risk, to be tested. RESULTS Using claims and laboratory data, 11% of the population was identified as having prediabetes. Of those 40-64 years of age, 25% were identified as being at higher risk, and 27% of them were tested or diagnosed within 1 year. Of employees exposed to the media campaign, 14% were tested or diagnosed within 1 year. Individuals with prediabetes were older, heavier, and more likely to have hypertension and dyslipidemia. Testing and diagnosis were associated with receiving medical care and provider outreach. A total of 8,129 individuals, or 42% of those with prediabetes, were identified. CONCLUSIONS Analysis of existing health insurance data facilitated the identification of individuals with prediabetes. Better identification of people with prediabetes is a first step in increasing uptake of the NDPP.
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Affiliation(s)
- William H Herman
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kevin Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Thomas Hurst
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Laura N McEwen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Somerville M, Ball L, Sierra-Silvestre E, Williams LT. Understanding the knowledge, attitudes and practices of providing and receiving nutrition care for prediabetes: an integrative review. Aust J Prim Health 2020; 25:289-302. [PMID: 31575387 DOI: 10.1071/py19082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/26/2019] [Indexed: 11/23/2022]
Abstract
To synthesise the literature on nutrition care for prediabetes from both the perspective of healthcare providers and patients, six databases (CINAHL, MEDLINE, Embase, PsycINFO, Scopus and ProQuest) were searched to identify qualitative or quantitative studies that focussed on nutrition care and prediabetes in primary care practice. Studies examining the perspectives of patients with prediabetes and healthcare providers were included. Outcomes of interest included knowledge of nutrition care for prediabetes, attitudes around providing or receiving nutrition care and actual nutrition care practices for prediabetes. Overall, 12851 studies were screened and 26 were included in the final review. Inductive analysis produced five themes: (i) nutrition care is preferable to pharmacological intervention; (ii) patients report taking action for behaviour change; (iii) healthcare providers experience barriers to nutrition care; (iv) healthcare providers tend not to refer patients for nutrition care; and (v) there are contradictory findings around provision and receipt of nutrition care. This review has revealed the contradictions between patients' and healthcare providers' knowledge, attitudes and practices around nutrition care for prediabetes. Further research is needed to shed light on how to resolve these disconnects in care and to improve nutrition care practices for people with prediabetes.
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Affiliation(s)
- Mari Somerville
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive Southport, Qld 4215, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive Southport, Qld 4215, Australia
| | - Eva Sierra-Silvestre
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive Southport, Qld 4215, Australia; and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Logan Campus, Meadowbrook, Qld 4131, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive Southport, Qld 4215, Australia; and Corresponding author.
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Lorenz A, Oza-Frank R, May S, Conrey EJ, Panchal B, Brill SB, RajanBabu A, Howard K. A quality improvement collaborative increased preventive education and screening rates for women at high-risk for type 2 diabetes mellitus in primary care settings. Prim Care Diabetes 2020; 14:335-342. [PMID: 31706949 DOI: 10.1016/j.pcd.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/19/2019] [Accepted: 09/30/2019] [Indexed: 01/11/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) rates continue to increase across women of reproductive age in the United States. The Ohio Type 2 Diabetes Learning Collaborative aimed to improve education and screening for T2DM among women aged 18-44years at high risk for developing T2DM. METHODS Fifteen primary care practices across Ohio participated in a 12-month quality improvement (QI) collaborative, which included monthly calls to share best practices, one-on-one QI coaching, and Plan-Do-Study-Act cycles. Monthly, practices submitted data on three outcome measures on preventive education and three measures on clinical screening for T2DM. RESULTS Increases across each of the three preventive education rates (range of percent increase: 53.6% - 60.0%) and each of the three screening rates for T2DM (15.0% - 19.4%) were observed. Specifically, screening rates for high-risk women with two or more risk factors for T2DM (excluding gestational diabetes mellitus (GDM)) increased by 16.8% (60.5%-77.3%) while rates for T2DM among women with a history of GDM increased by 15.0% (75.0 - 90.0). CONCLUSIONS A quality improvement collaborative increased preventive education and screening rates for women at high-risk for T2DM in primary care settings.
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Affiliation(s)
- Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
| | - Reena Oza-Frank
- Ohio Department of Health, 246 N. High Street, Columbus, OH 43215, United States
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States.
| | - Elizabeth J Conrey
- Ohio Department of Health, 246 N. High Street, Columbus, OH 43215, United States
| | - Bethany Panchal
- Ohio State University Rardin Family Practice, The Ohio State University Wexner Medical Center, 2231 N. High St., Columbus, OH 43201, United States
| | - Seuli Bose Brill
- Internal Medicine/Pediatrics at Grandview Yard, The Ohio State University Wexner Medical Center, 895 Yard Street, Columbus, OH 43212, United States
| | - Arun RajanBabu
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
| | - Kristin Howard
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
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Roper KL, Thomas AR, Hieronymus L, Brock A, Keck J. Patient and Clinician Perceptions of Prediabetes: A Mixed-Methods Primary Care Study. DIABETES EDUCATOR 2019; 45:302-314. [DOI: 10.1177/0145721719845347] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of the study was to assess patient and clinician perceptions of prediabetes in an academic family medicine practice. Data were collected in preparation for an implementation study to increase utilization of the National Diabetes Prevention Program (N-DPP). Methods In this mixed-methods study, discussions from 3 focus groups composed of patients with prediabetes were evaluated using thematic analysis for their understanding of and beliefs about prediabetes, care experiences, and attitudes toward N-DPP. Clinicians completed a Likert-scaled survey assessing attitudes and perceived barriers to providing prediabetes care. Results Among the 15 focus group participants, more than half were not aware of their diagnosis. Attitudes toward prediabetes were mixed: while many believed it was serious and elicited more fear than being “at risk,” others thought there were varying degrees of risk within the same diagnosis, making the diagnosis less impactful. Patients repeatedly expressed the perception that clinicians were not forthcoming about necessary behavior changes. Patients agreed on barriers to N-DPP, including scheduling and transportation. Clinicians (N = 31) concurred that patients lack awareness of their prediabetes diagnosis. They reported that time is available to screen all patients and that a prediabetes diagnosis is effective for advising patients of the need for lifestyle modification. There was consensus from both patients and clinicians that prediabetes is curable. Conclusions Increased patient awareness and patient-centered education is needed to overcome barriers to prediabetes care. To facilitate implementation of N-DPP referral processes, clinicians should clearly communicate risk, treatment information, and linkage to N-DPP as the suggested treatment plan.
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Affiliation(s)
- Karen L. Roper
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Alisha R. Thomas
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Laura Hieronymus
- University of Kentucky College of Medicine, Barnstable Brown Diabetes Center, Lexington, Kentucky
| | - Audrey Brock
- American Board of Family Medicine, Lexington, Kentucky
| | - James Keck
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky
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Nhim K, Khan T, Gruss SM, Wozniak G, Kirley K, Schumacher P, Luman ET, Albright A. Primary Care Providers' Prediabetes Screening, Testing, and Referral Behaviors. Am J Prev Med 2018; 55:e39-e47. [PMID: 29934016 PMCID: PMC6241213 DOI: 10.1016/j.amepre.2018.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/16/2018] [Accepted: 04/10/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Intensive behavioral counseling is effective in preventing type 2 diabetes, and insurance coverage for such interventions is increasing. Although primary care provider referrals are not required for entry to the Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Program lifestyle change program, referral rates remain suboptimal. This study aims to assess the association between primary care provider behaviors regarding prediabetes screening, testing, and referral and awareness of the CDC-recognized lifestyle change program and the Prevent Diabetes STAT: Screen, Test, and Act Today™ toolkit. Awareness of the lifestyle change program and the STAT toolkit, use of electronic health records, and the ratio of lifestyle change program classes to primary care physicians were hypothesized to be positively associated with primary care provider prediabetes screening, testing, and referral behaviors. METHODS Responses from primary care providers (n=1,256) who completed the 2016 DocStyles cross-sectional web-based survey were analyzed in 2017 to measure self-reported prediabetes screening, testing, and referral behaviors. Multivariate logistic regression was used to estimate the effects of primary care provider awareness and practice characteristics on these behaviors, controlling for provider characteristics. RESULTS Overall, 38% of primary care providers were aware of the CDC-recognized lifestyle change program, and 19% were aware of the STAT toolkit; 27% screened patients for prediabetes using a risk test; 97% ordered recommended blood tests; and 23% made referrals. Awareness of the lifestyle change program and the STAT toolkit was positively associated with screening and referring patients. Primary care providers who used electronic health records were more likely to screen, test, and refer. Referring was more likely in areas with more lifestyle change program classes. CONCLUSIONS This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.
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Affiliation(s)
- Kunthea Nhim
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Stephanie M Gruss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kate Kirley
- American Medical Association, Chicago, Illinois
| | - Patricia Schumacher
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth T Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
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