904-P: Identification, Diagnosis, and Treatment of Prediabetes in Veterans at VA Central Iowa

Abstract

The prevalence of type 2 diabetes is high with approximately 24% of Veterans having the diagnosis and 70% being at high risk. In addition to traditional risk factors for diabetes, Veteran have a unique risk factor of Agent Orange exposure in Vietnam. Despite this increased risk, only 17 Veterans at VA Central Iowa had the prediabetes ICD-10 code R73.03. The Diabetes Prevention Program (DPP) indicates that lifestyle changes can reduce the progression to type 2 diabetes up to 58% in those under 60 and by 71% in those 60 or older. We piloted a process to identify, diagnose and treat prediabetes in one primary care team. After the 5-month pilot, prediabetes diagnosis rates increased by 5 times the pre-intervention rate (17 to 85). After all primary care providers and nurses received education on how to identify, diagnosis, and treat prediabetes, surveyed providers indicated they were more likely to diagnose and treat prediabetes according to evidence-based guidelines. After this 3-month staff education series, prediabetes diagnosis facility rates increased by 6 times the pre-intervention rate (67 to 421). The Prediabetes Identification Dashboard and Treatment Plan Tool was created after the pilot to identify Veterans at risk for diabetes. The tool can determine if referrals such as Nutrition, Diabetes Education, weight loss clinic, metformin, or a weight loss medication were used. In 2018, this tool identified 7,299 (28.4%) of Veterans at VA Central Iowa who were at risk for diabetes. Of the 7,299 Veterans, 2,932 (11.4%) were at high risk for prediabetes and diabetes since they’ve had one A1C between 5.7-6.4%. It’s essential for Primary Care staff to provide prediabetes education at the time of diagnosis. During the pilot, 97% of the Veterans wanted to receive education in Primary Care and declined referrals. This prediabetes pilot, education series, and prediabetes dashboard tool will be implemented at regional VA sites to improve prediabetes care and prevent progression to diabetes. Disclosure G. Thorson: None. J.M. Patterson: None. K. Jorgensen: None. Z.P. Veigulis: None.