The Effectiveness of a Proactive, Three-Level Strategy to Identify People With Prediabetes in a Large Workforce With Employer-Sponsored Health Insurance

Herman, William H.; Joiner, Kevin L.; Hurst, Thomas E.; McEwen, Laura N.

doi:10.2337/dc20-3112

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…There is also evidence that joint parent-child interventions and parent-only interventions lead to direct effects on children's weight loss (10)(11)(12)(13)(14)(15). Given these past studies and the demonstrated efficacy of DPPs in promoting the adoption of healthy diet and activity habits (18), parental participation in the DPP might lead to improvements in BMI percentile of their dependent children. However, in this study, parental participation in the DPP was not specifically designed to influence children's BMI percentile.…”

Section: Discussionmentioning

confidence: 99%

“…Beginning in August 2015, a large research university in the Midwestern United States offered its self-insured employees, dependents, and retirees with prediabetes and obesity the option of participating in a one-year DPP at no out-of-pocket cost. The university used a tiered intervention strategy to identify individuals with prediabetes (18). Between 2015 and 2018, individuals with prediabetes were sent letters encouraging them to join a DPP (18).…”

Section: Methodsmentioning

confidence: 99%

“…The university used a tiered intervention strategy to identify individuals with prediabetes (18). Between 2015 and 2018, individuals with prediabetes were sent letters encouraging them to join a DPP (18). For this current study, baseline and one-year follow-up surveys were administered to all individuals with prediabetes who enrolled in a DPP and a random sample of those who had not enrolled.…”

Section: Methodsmentioning

confidence: 99%

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The Effect of Parental Diabetes Prevention Program Participation on Weight Loss in Dependent Children: A Prospective Cohort Study

Atluri

Thariath

McEwen

et al. 2022

Preprint

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Introduction: Obesity has reached epidemic proportions in children and adolescents in the United States. Children’s behaviors are strongly influenced by parental behaviors, and weight loss in parents is positively associated with weight changes in their overweight/obese children. Research is limited on how parents’ National Diabetes Prevention Program (DPP) participation affects the health outcomes of their dependent children. Analyzing the impact of parental DPP participation on weight loss in their dependent children may provide valuable insight into an important secondary benefit of DPP participation. Methods: In this study, we identified 128 adults with prediabetes who were offered the opportunity to participate in a DPP (n = 54 DPP participants and n = 74 DPP non-participants) and who had at least one child 3 to 17 years of age living with them. Age and BMI percentile for dependent children were collected from insurance claims data for 203 children (n = 90 children of DPP participants and n = 113 children of DPP non-participants). Children’s changes in diet and physical activity, as assessed by parental surveys, were reported as secondary outcomes. Results: There were no significant changes in BMI percentiles of overweight or obese children (i.e. BMI percentile ≥ 50%) of DPP participants vs DPP non-participants with prediabetes over one-year. Parents who enrolled and did not enroll in the DPP did not differ in the advice they reported giving to their children about eating a healthy diet or engaging in regular physical activity. Discussion: These results are not consistent with the literature that suggests parent-based interventions may influence their children’s weight trajectories. Limitations include small sample size, short time span of intervention, and limited availability of additional health/biographic data on dependent children. Future studies should collect primary outcome data on children, investigate whether there is a minimum duration of parental involvement and level of parental adherence, and assess the effect of parent-child dynamics on child weight trajectories.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Effect of Parental Diabetes Prevention Program Participation on Weight Loss in Dependent Children: A Prospective Cohort Study

Atluri

Thariath

McEwen

et al. 2022

Preprint

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“…We identified 64,131 university employees, dependents, and retirees ≥ 18 years of age without evidence of Type 1 or Type 2 diabetes mellitus and identified 8,131 of them (12.7%) as having prediabetes and overweight or obesity based on health plan records [ 5 ]. Prediabetes was defined by either a health plan claims diagnosis of prediabetes or a hemoglobin A1c (HbA1c) level of 5.7 to 6.4% (39 to 46 mmol/mol).…”

Section: Subjects Materials and Methodsmentioning

confidence: 99%

Uptake, retention, and outcomes of the National Diabetes Prevention Program by enrollee characteristics and program type

Herman

Villatoro

Joiner

et al. 2023

Diabetes Research and Clinical Practice

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“…These strategies were described previously. 16 Strategy 1 (members with pre-diabetes) Enrollment, claims, pharmacy, and laboratory data were used to identify Premier Care members ≥18 years of age without evidence or diagnoses of diabetes mellitus but with one or more of the following: (1) claims for impaired fasting glucose (International Classification of Diseases, Ninth revison (ICD-9) 790.21 or ICD, Tenth revision (ICD-10) R73.01), impaired glucose tolerance (ICD-9 790.22 or ICD-10 R73.02), or other abnormal glucose (ICD-9 790.29 or ICD-10 R73, R73.0, R73.09, and R73.9), and (2) hemoglobin A1c (HbA1c) levels between 5.7% (39 mmol/mol) and 6.4% (46 mmol/mol) in the preceding 3 years (ADA criterion for pre-diabetes). 17 Every 6 months, these criteria were used to identify individuals with pre-diabetes.…”

Section: Methodsmentioning

confidence: 99%

Use of metformin following a population-level intervention to encourage people with pre-diabetes to enroll in the National Diabetes Prevention Program

Hurst

McEwen

Joiner

et al. 2021

BMJ Open Diab Res Care

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IntroductionThe National Diabetes Prevention Program (NDPP) and metformin are interventions to slow progression from pre-diabetes to type 2 diabetes. When coverage for the NDPP was offered by a public research university’s health insurance plan, proactive strategies were used to combat historically low enrollment. Although not specifically targeted by these strategies, metformin use was higher than expected, leading to this evaluation.Research design and methodsWe used insurance enrollment, claims, pharmacy, and laboratory data for 64 131 adult employees, dependents, and retirees to identify individuals with pre-diabetes and invite them to enroll in the NDPP at no out-of-pocket cost. The characteristics of individuals with pre-diabetes who used metformin before and after their invitation were compared with NDPP enrollees.Results8131 individuals with pre-diabetes were identified. Of these, 776 (9.5%) enrolled in a NDPP and 802 (9.9%) used metformin. Metformin users were younger, had higher body mass index, were more likely to have comorbidities, and had higher baseline hemoglobin A1c levels than non-users. Timing of metformin use varied with 107 (13%) discontinuing, 426 (53%) continuing, and 269 (34%) initiating metformin use after their NDPP invitation. Of NDPP enrollees, 13 (2%) discontinued, 56 (7%) continued, and 34 (4%) initiated metformin use when they enrolled.ConclusionsDespite no active encouragement, use of metformin was similar to the rate of enrollment in the NDPP. Metformin use was higher for individuals with higher likelihood of responding. With the proven cost-effectiveness of metformin, targeted strategies to increase metformin use in individuals with pre-diabetes who are likely to respond, but not willing to enroll in a lifestyle intervention, are needed.

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The Effectiveness of a Proactive, Three-Level Strategy to Identify People With Prediabetes in a Large Workforce With Employer-Sponsored Health Insurance

Cited by 8 publications

References 21 publications

The Effect of Parental Diabetes Prevention Program Participation on Weight Loss in Dependent Children: A Prospective Cohort Study

The Effect of Parental Diabetes Prevention Program Participation on Weight Loss in Dependent Children: A Prospective Cohort Study

Uptake, retention, and outcomes of the National Diabetes Prevention Program by enrollee characteristics and program type

Use of metformin following a population-level intervention to encourage people with pre-diabetes to enroll in the National Diabetes Prevention Program

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