Implementation and Evaluation of a Diabetes Prevention Clinical Pathway in Primary Care

Not Applicable

Completed

Conditions: Prediabetic State
PreDiabetes

Interventions: Other: START diabetes prevention clinical pathway

Registration Number: NCT05265312

Lead Sponsor: Johns Hopkins University

Brief Summary: Prediabetes is a significant public health problem affecting 88 million U.S. adults. Evidence suggest that the vast majority of people with prediabetes are unaware of having this condition and many are not receiving appropriate care for prediabetes, including referral to evidence-based programs like the Diabetes Prevention Programs (DPP). In the investigator's retrospective cohort study of patients with prediabetes from Johns Hopkins Health Systems, the investigators found that the rates of prediabetes clinical care activities are low. In the investigators' qualitative studies, the investigators found that primary care physician (PCP) barriers include low knowledge about Diabetes Prevention Programs and misperceptions of insurance coverage of these programs and inadequate clinical staff to address prediabetes. Common patient barriers to taking action to prevent diabetes include lack of motivation, time and resources.

Based on prior research, comprehensive strategies are urgently needed to improve prediabetes care. Using these findings, the investigators have designed and plan to implement a diabetes prevention clinical pathway which seeks to address some of these common clinician and patient barriers. The investigators hypothesize that the clinical pathway will result in increased clinician screening and intervention and improve patient engagement in diabetes prevention. The investigators will compare results from the intervention clinic compared to a control clinic. If successful, the investigators plan to implement and test the effectiveness of this clinical pathway across the entire health system.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1910

Inclusion Criteria

Prediabetes based on prediabetes registry
Age ≥ 18 years
PCP visit during intervention period
Patient of Johns Hopkins Green Spring Station (GSS) General Internal Medicine or Johns Hopkins Community Physicians (JHCP) Internal Medicine clinic.

Exclusion Criteria

Visit with clinician who's not their Primary Care Physician (PCP)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention clinic	START diabetes prevention clinical pathway	Patients with prediabetes seen for routine care at intervention clinic

Primary Outcome Measures

Name	Time	Method
Number of PCP Visits Where Ppt Was Referred to Diabetes Prevention Program Within 30 Days of Visit	12 months	Number of PCP visits where ppt referred to Diabetes Prevention Program during intervention period
Number of PCP Visits Where Ppt Was Prescribed Metformin Within 30 Days	12 months
Number of PCP Visits Where Ppt Was Referred to Medical Nutrition Therapy Within 30 Days	12 months

Secondary Outcome Measures

Name	Time	Method
Number of Participants Who Complete Glycemic Lab Testing Out of Those With an Order During Intervention Period	12 months	Fasting glucose or Hemoglobin A1c
Achieve 5% or Greater Reduction in Weight Compared to Baseline	Baseline and 12 months	Proportion achieving 5% or greater weight reduction