Aiding Screening, Diagnosis, and Management of Prediabetes Among High-Risk Medicare Patients in a Primary Care Setting

Purpose: Encourage prediabetes screening, testing, and referral to a CDC-recognized Diabetes Prevention Program (DPP) as a first-line treatment. Background: The prevalence of diabetes and prediabetes incidence is highest among Medicare-eligible Washingtonian patients, with 19% and 16%, respectively. DPP results in a 71% reduction of diabetes incidence in 65 years and older. However, only 3% of healthcare sites screen, test, and refer to DPP. Design: Quality assessment with a descriptive quantitative evaluation method was conducted using Retrospective Chart Review for patients who visited Franciscan primary clinics from 08/31/2019 to 08/31/2020. A total of 1250 Medicare patients were extracted from a convenient sample. Risk factors for prediabetes were identified for 224 patients, including, a first-degree family history of diabetes, history of hypertension, age, race/ethnicity, physical activity, sex, history of gestational diabetes, height, and weight and were entered into the online American Diabetes Association prediabetes risk-test. The number of patients who fulfilled the criteria for a diagnosis of prediabetes based on Fasting Plasma Glucose, Glycated Hemoglobin A1c and Random Glucose was 685. Four patients had mixed laboratory results and were excluded; the remaining 681 were considered for prediabetes management. The number of patients who did not fulfill laboratory criteria for prediabetes was 565. Results: All the 224 patients (100%) had risk-test scores of at least 5. The prevalence of misdiagnosis of blood glucose was 45.2%. All of the 681 patients (100%) meeting requirements of prediabetes were not referred to DPP. Only 26 patients (3.8%) were managed by either metformin (3.1%) or referral to diabetes education (0.7%). Conclusion: Medicare patients at high risk are not routinely screened, tested, and managed by DPP, metformin, or diabetes education. Implication: Practice change needs assessment of PCP awareness about diabetes risk-test, prediabetes laboratory parameters, and management by referral to DPP