Novel Use and Utility of Integrated Electronic Health Records to Assess Rates of Prediabetes Recognition and Treatment: Brief Report From an Integrated Electronic Health Records Pilot Study

Abstract

OBJECTIVEThis study uses novel methods to examine the frequency of diagnosis and treatment of prediabetes in real-world clinical settings using electronic health record (EHR) data.RESEARCH DESIGN AND METHODSWe identified a cohort of 358,120 adults with incident prediabetes (fasting plasma glucose [FPG] 100–125 mg/dL or glycated hemoglobin 5.7–6.4% [39–46 mmol/mol]) between 2006 and 2010 and examined rates of diagnosis and treatment in the 6 months after identification.RESULTSIn the 6 months after identification of prediabetes, 18% of patients had their blood glucose levels retested; 13% received a physician diagnosis of prediabetes/hyperglycemia; 31.0% had prediabetes, diabetes, or lifestyle documented in the clinical notes; and <0.1% initiated metformin. Among patients with FPG 120–125 mg/dL, 31% were retested; metformin initiation remained <1%.CONCLUSIONSDocumented rates of follow-up and treatment for prediabetes are low. EHR data may be a valuable tool to improve identification and treatment of prediabetes in the U.S.

Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012

“…Although we observed a metformin prescription prevalence of 3.7%, which is higher than the prevalence of less than 0.1% previously reported by Schmittdiel and colleagues (15), it still represents underuse of a highly effective prevention strategy. Schmittdiel and colleagues only reported metformin use within 6 months of prediabetes identification, but our study examined the prevalence of metformin prescription over a 3-year study window.…”

“…In addition, both providers and patients may place higher priority on other medical needs or be reluctant to “medicalize” prediabetes (15). Patients and providers may also lack awareness of prediabetes, specifically the natural disease course that can result in incident diabetes in 30% of patients within 3 to 4 years (28) and the associated risks (for example, microvascular complications) (3).…”

“…The only published study to include incidence of metformin use among patients with prediabetes found that fewer than 0.1% were prescribed metformin (15). However, these data were collected from an integrated health delivery system that may not accurately reflect wider practice patterns and were reported for only 1 time point within 6 months of prediabetes identification.…”

The global agenda for the prevention of type 2 diabetes

“…32 Despite these data, 2 recent, large, managed-care database studies, the smaller of which included over 17 000 patients with newly diagnosed prediabetes, found that fewer than 4% of patients with prediabetes receive prescriptions for metformin within 3 years of diagnosis. 33,34 …”

Frontline Account: Resident-led Implementation of the National Diabetes Prevention Program within Primary Care Clinics of a Large, Academic Medical Center

“…This anecdotal observation is congruent with literature suggesting that only 5 % of prediabetic individuals are referred to health education, wellness, or lifestyle programs. 5 Through discussion with our clinic preceptors and coresidents, we discovered that many clinicians were unaware of the NDPP and available community programs. Other physicians were aware of the NDPP, but rarely referred patients to participate, given the approximate out-of-pocket expense of $500 per participant per year.…”