Provider Practices in Prediabetes Management and the Prevention of Type 2 Diabetes

In the United States, diabetes afflicts 24 million, is the fifth leading cause of death, and, in 2007, cost approximately 200 billion dollars. One approach to mitigating the increasing social and economic burden of the disease is through prevention efforts directed at the estimated 57 million Americans living with prediabetes. Despite large-scale clinical trials demonstrating the effectiveness of lifestyle intervention in preventing or delaying the progression of prediabetes to Type 2 diabetes, there is a scarcity of literature addressing provider practices in the diagnosis and management of prediabetes. The purpose of this study was to investigate provider practices in prediabetes care and to determine to what extent various socioeconomic variables, body mass index, and provider type predict the provision of recommendations for intervention in the medical office setting. A descriptive and relational study was performed utilizing an electronic medical record database containing the records of approximately 82,000 individuals. Among the findings, the diagnosis rate for patients who had documented criteria for prediabetes (n=848) was low (9.9%) and only 15% of individuals with prediabetes were counseled to participate in lifestyle intervention programs. Referral rates were highly associated with such variables as age, body mass index, and race. Implications for using electronic medical record design in improving patient outcomes, medical office policy, and provider education as well as future research will be discussed.