Impact of Integrating the American Diabetes Association Diabetes Risk Test on Prediabetes Screening and Diagnosis Incidence Rates and Clinical Outcomes

Abstract

Approximately 84 million adults are living with prediabetes in the US, and approximately 10% are aware of their condition, suggesting inadequate screening. Using the American Diabetes Association Diabetes Risk Test (ADART), which is a risk assessment tool for prediabetes screening with point-of-care testing using HbA1c, has identified significant numbers of prediabetics. Primary care providers’ (PCPs) use of ADART to screen and diagnose prediabetes allows interventions to prevent progression to type 2 diabetes mellitus (T2DM). This quality improvement (QI) project examined the impact of PCPs using the ADART on the incidence of prediabetes screening and diagnosis in one primary care clinic. The aims were to examine: 1) percentages of patients diagnosed with prediabetes pre- and post-ADART implementation; 2) PCP compliance with ADA guidelines for Diabetes Prevention Program (DPP) referrals; 3) participant compliance with scheduled 3-month follow-up visit for weight and HbA1c; and 4) participant compliance with ADA therapeutic lifestyle changes (TLI) to reverse prediabetes.

This QI project used a quasi-experimental pretest-posttest-study design. A convenience sample of participants aged 18 years or older, without previous diagnoses of prediabetes or T2DM was recruited at the study clinical site over 30 days. Patients with ADART score of 5 or greater received HbA1c laboratory test to confirm prediabetes followed by DPP referral. The incidence of prediabetes diagnoses with ADART intervention was compared to a retrospective 30-day pre-ADART intervention incidence of prediabetes diagnoses.

A variety of descriptive statistics were used to describe sociodemographic and clinical characteristics of the sample, and the number of participants screened pre- and post-ADART implementation. Paired sample t-test was used to compare participant weight, BMI, and HbA1c levels pre/post TLI activities. The sample had a mean age of 57.2 ±11.4 years, was primarily female, Caucasian, and obese. Significantly more patients were diagnosed with prediabetes in the ADART intervention group (n=70) compared to the pre-ADART group (n=20) (z = 6.10, p

Keywords: prediabetes, prediabetes diagnoses, diabetes prevention, screening, primary care setting, and diagnosis