Clinical Identification and Referral of Adults With Prediabetes to a Diabetes Prevention Program
IMPLEMENTATION EVALUATION — Volume 16 — June 27, 2019
PEER REVIEWED
The handout instructs clinicians to query electronic health records to identify patients with prediabetes by using the following inclusion criteria: age 65 or older, BMI of 25 or higher (≥23 for Asian patients), Medicare or Medicare Advantage insurance, and with any of these test values (test performed within 12 months): HbA1c (5.7–6.4) and/or fasting plasma glucose 100–125 mg/dL and/or oral glucose tolerance test (140–199 md/dL). Exclusion criteria are insulin use, previous diagnosis of diabetes. Refer to the YMCA’s Diabetes Prevention Program. Retest annually. The handout includes the following table of blood test levels for diagnosis of diabetes and prediabetes:
| Values | Diagnostic Test | ||
|---|---|---|---|
| HbA1c | Fasting Plasma Glucose, mg/dL | Oral Glucose Tolerance Test, mg/dL | |
| Normal | <5.7 | <100 | <140 |
| Prediabetes | 5.7–6.4 | 100–125 | 140–199 |
| Diabetes | ≥6.5 | ≥126 | ≥200 |
| Action | Retest within 3 years of last negative test | Refer to a lifestyle change program; annually, retest for diabetes onset | Confirm diagnosis and retest if necessary; counsel the patient on diagnosis and initiate therapy |
Figure 1.
Handout for clinical practices used in YMCA’s Diabetes Prevention Program showing the retrospective prediabetes identification and intervention algorithm developed by the American Medical Association to identify patients with prediabetes for referral to the program. Abbreviations: BMI, body mass index; EHR, electronic health record; HbA1C, hemoglobin A1c.
The handout is divided into 4 sections and provides the following instructions for the clinician: 1) Measure at check-in: If patient is aged 18 or older and does not have diabetes, provide CDC prediabetes screening test or American Diabetes Association diabetes risk test. Have patient complete test and return it. Insert completed test in paper chart or note risk score in the electronic medical record. Take rooming/vitals: Calculate BMI (weight in kg divided by height in meters squared) and review diabetes risk score. If patient has an elevated risk score or a history of gestational diabetes mellitus, flag for possible referral. 2) Act to perform examination and consultation: Follow point-of-care prediabetes identification algorithm, determine if the patient has prediabetes and a BMI at or above 25 (23 for Asian patients), advise regarding diet and exercise, and determine patient’s willingness to participate in a diabetes prevention program. If patient agrees to participate, proceed with referral. 3) Partner. Referral: Complete and submit the referral form via fax or email. 4) Follow-up: Contact patient and troubleshoot issues with enrollment or participation.
Figure 2.
Handout for clinical practices used in the YMCA’s Diabetes Prevention Program showing a patient workflow process using point-of-care methods to identify candidates for referral to the program. Abbreviations: ADA, American Diabetes Association; CDC, BMI, body mass index; Centers for Disease Control and Prevention; EMR, electronic medical record; GDM, gestational diabetes mellitus.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.