Does your patient know if they have prediabetes?

BACKGROUND: Prediabetes is common; 1 in 3 people have prediabetes, but 9 out of 10 people with prediabetes do not know that they have it. Among those with prediabetes, 25% will progress to diabetes in 3-5 years. MaineHealth has now implemented Diabetes Prevention Program classes, based on a major multicenter clinical research study that showed structured lifestyle interventions can cut the risk of developing type 2 diabetes in half for pre-diabetic participants. This program is available to all patients, free of charge, but in order for patients to participate, they first need to know if they have prediabetes and be referred by a provider. Our study aimed to identify how frequently our patients have lab-defined prediabetes but do not have this listed on their problem list. METHODS: De-identified patient data was collected through a retrospective chart review using the electronic health record (EPIC). We included patients age 18 and over who had at least one office visit between 7/1/2016 to 6/30/2018 and at least a HgA1C lab or a fasting glucose lab. The data also included, for every patient, whether they had the diagnosis codes for pre-diabetes (including all ICD10 codes R73.**) and/or for diabetes, type 1 and type 2 (including all ICD10 codes E10** and ICD10 codes E11.**). RESULTS: 7,770 patients met the inclusion criteria. 1,896 patients (24%) had an elevated A1C (A1C 5.7-6.4) and/or Fasting Blood Glucose (100-125) in the prediabetes range. 930 patients (12%) had an elevated A1C (? 6.5) and/or Fasting Blood Glucose (? 126) in the diabetes range. Of the 1896 patients with lab defined prediabetes, 474 (25%) had Prediabetes on the problem list, 740 (39%) had Diabetes on the problem list, and 682 (36%) had Neither diagnosis on the problem list. Of the 930 patients with lab defined diabetes, 809 (87%) had Diabetes on the problem list, 37 (4%) had Prediabetes on the problem list, and 84 (9%) had Neither diagnosis on the problem list. Among the 1896 patients with lab defined Prediabetes there were 23 patients age 18-24 and among that age group 13 (56%) had Neither Prediabetes or Diabetes on the problem list. There were 223 patients age 25-40 with lab defined Prediabetes and among that age group 129 (57.8%) had Neither Prediabetes or Diabetes on the problem list. These two results were in contrast to the 992 patients age 41-64 that had 346 (34.9%) and the 658 patients age 65 and older that had 199 (30.2%) of patients with Neither Prediabetes or Diabetes on the problem list. CONCLUSION: Among patients age 18 and older at the MMP Family Medicine clinics in Portland and Falmouth we are ordering labs that could help us diagnose our patients with prediabetes, but only one quarter of our patients with lab-defined Prediabetes have this on the problem list. At our MMP Family Medicine clinics adults age 18-40 are most likely to be unaware of their prediabetes diagnosis. More work is needed to identify these patients to prevent the progression to Diabetes