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Few adults with prediabetes referred to, participating in diabetes prevention programs

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February 4, 2019

Only a minority of U.S. adults with prediabetes who are eligible to participate in a national diabetes prevention program are doing so, with just 4% referred and 2% participating, according to findings published in the American Journal of Preventive Medicine.

In an analysis of 2016 data from the National Health Interview Survey, more than one-quarter of likely eligible adults also reported interest in participating in a yearlong lifestyle intervention program to treat type 2 diabetes, according to the researchers, suggesting a need to improve program access and referral efforts.

Maya Venkataramani, MD, MPH, assistant professor of medicine at the Johns Hopkins University School of Medicine, and colleagues analyzed data from 2,341 adults without a self-reported diabetes diagnosis, who were likely eligible for diabetes prevention programming based on a self-reported diagnosis of prediabetes or gestational diabetes and/or meeting BMI criteria (63% women; 74.6% white; 68.2% aged 45 years). Researchers determined the prevalence of self-reported referral and participation and used logistic regression analyses to characterize sociodemographic correlates of referral, participation and interest.

Researchers found that 4.2% of the cohort reported ever being referred to a 12-month prevention program and only 2.4% reported ever participating. In logistic regression analyses, researchers found that race correlated with referral, with black and Asian adults more likely to report referral. Age was positively correlated with participation, with adults aged at least 65 years more likely to participate vs. adults aged 44 years or younger.

Additionally, 26.2% of adults who were never referred to a program reported an interest in engaging or participating in a program. Increasing BMI was associated with higher odds of expressing interest, as was being black and Hispanic, according to researchers.

“This study represents an initial step in characterizing the reach of diabetes prevention programming among adults aware of their prediabetes status and likely eligible to participate and benefit from the intervention, supplementing existing literature describing current participant characteristics,” the researchers wrote. “Low rates of referral and participation suggest that efforts to enhance identification, recruitment and retention of high-risk adults from clinical and community-based settings will be essential to realizing the potential of lifestyle interventions for diabetes prevention.” – by Regina Schaffer

Disclosure: One of the authors reports he owns stock in Gilead Pharmaceuticals.

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Eva M. Vivian

More effective strategies to promote diabetes prevention programs within the clinical and community settings are sorely needed. Nonphysician providers and other medical staffers, including medical assistants and community health workers, are currently underutilized in the referral process and should be an active part of the identification and referral process.

Identification and referral should also be expanded outside of the clinic and hospital settings. Health care organizations should partner with churches, civic groups and community centers to identify and recruit high-risk adults for lifestyle interventions for diabetes prevention.

Diabetes prevention programs should be appealing and meet the needs of the target group. Programs that include the family and offer strong social support with face-to-face interactions with peers and professionals have the best retention. Work and child-related responsibilities are potential barriers to participation for most women, therefore, programs that include childcare support may increase attendance.

Eva M. Vivian, PharmD, MS, CDE, BC-ADM, FAADE

University of Wisconsin School of Pharmacy
Madison, WI

Disclosure: Vivian reports no relevant financial disclosures.