Improving Identification of Prediabetes and Undiagnosed Diabetes in Primary Care
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Authors
Gwaltney, Annette
Issue Date
2021-04-29
Type
Thesis
Language
en_US
Keywords
Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Caring sciences::Nursing , Prediabetic State , Diabetes Mellitus, Type 2 , ADART , Health Screening
Alternative Title
Description/Abstract
84.1 million Americans over 18 have prediabetes, with 88.4% of those individuals remaining undiagnosed. Early diagnosis and treatment of prediabetes can prevent or deter Type 2 Diabetes Mellitus (T2DM). The American Diabetes Association (ADA) screening guidelines for T2DM focus on symptomatic individuals 45 and older. No standard risk assessment tool is in place for screening prediabetes and T2DM for asymptomatic, non-pregnant patients 18-44 years of age. Methods: Non-pregnant patients aged 18-44, without a diagnosis of prediabetes or T2DM, completed the ADA Diabetes Risk Test (ADADRT) during intake. ADADRT scores of 5 or greater received behavioral modification education and provider referral for diagnostic testing using A1C or fasting plasma glucose (FPG). Providers documented referral for testing and education provided in EHR. Patients with lab values in the prediabetes or T2DM range were notified of results and scheduled for a two-week return appointment, at which time providers used the treatment algorithm to determine the proper treatment. Interventions: ADADRT was used to guide providers on appropriate referrals for diagnostic testing and patient education. Lab results and the treatment algorithm determined appropriate treatment. Results: Staff administered the ADADRT to a convenience sample of 53 patients meeting participant criteria the ADADRT. Provider use of the ADADRT was documented 100% from the date of implementation. Secondary outcomes show the use of ADADRT increased proper screening for prediabetes and undiagnosed T2DM in the 18 – 44-year-old patient population by 19%. Fourteen at-risk patients were identified and received appropriate education and referral for diagnostic testing. Six patients had laboratory findings in the prediabetic range, received 100% follow-up and a treatment plan. Conclusions: ADADRT is effective as an assessment tool and improved patient identification for risk for prediabetes and T2DM. The provider educated at-risk patients on the benefits of behavior modification, ADA diet, and exercise recommendations and referred patients for diagnostic testing. Provider and patient discussed treatment options using the treatment algorithm provided. Keywords: prediabetes, risk assessment, evidence-based practice, prevention, diabetes