A quantitative measure of diabetes risk in community practice impacts clinical decisions

The PREVAIL initiative

B. R. Shah, M. Cox, S. E. Inzucchi, J. M. Foody, L. O. Zimmer, C. B. Jorge, R. E. Ratner, T. A. Barringer, Darren K McGuire, E. D. Peterson

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and aims: While predictive tools are being developed to identify those at highest risk for developing diabetes, little is known whether these assays affect clinical care. Methods and results: Thirty sites who used the PreDx® (Tethys BioScience, Emeryville, CA) abstracted clinical information from baseline clinic visits prior to a PreDx test and from the most recent visit at time of abstraction. All visits occurred between May 2008-April 2011 (median follow-up 198 days, IQR 124-334). The primary analysis was the influence of the PreDx test (5-year diabetes prediction) on subsequent care; descriptive statistics were used to summarize baseline and follow-up variables. Overall 913 patients with 2 abstracted visits were included. Relative to baseline, median SBP decreased 1.5mmHg (p=0.039), DBP decreased 2mmHg (p<0.001), LDL-C decreased 4mg/dL (p=0.009), and HDL-C increased 2mg/dL (p<0.001) at follow-up. Behavioral or lifestyle counseling was not significantly different from baseline to follow-up (71.2% vs. 68.1% (p=0.077), but BMI was lower by 0.2kg/m2 at follow up (p=0.013). At follow-up, more patients were prescribed metformin (13.7% vs. 9.7%, p<0.001). A higher PreDx score was significantly associated with metformin prescription (p=0.0003), lifestyle counseling (p=0.0099), and a lower BMI at follow-up (p=0.007). Conclusion: The use of a prognostic test in patients perceived to be high risk for diabetes was associated with a modest but significant increase in the prescription of metformin and lifestyle interventions and a reduction in BMI.

Original languageEnglish (US)
Pages (from-to)400-407
Number of pages8
JournalNutrition, Metabolism and Cardiovascular Diseases
Volume24
Issue number4
DOIs
StatePublished - 2014

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Metformin
Life Style
Prescriptions
Counseling
Ambulatory Care

Keywords

  • Diabetes mellitus
  • Quality improvement
  • Risk prediction

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

A quantitative measure of diabetes risk in community practice impacts clinical decisions : The PREVAIL initiative. / Shah, B. R.; Cox, M.; Inzucchi, S. E.; Foody, J. M.; Zimmer, L. O.; Jorge, C. B.; Ratner, R. E.; Barringer, T. A.; McGuire, Darren K; Peterson, E. D.

In: Nutrition, Metabolism and Cardiovascular Diseases, Vol. 24, No. 4, 2014, p. 400-407.

Research output: Contribution to journalArticle

Shah, BR, Cox, M, Inzucchi, SE, Foody, JM, Zimmer, LO, Jorge, CB, Ratner, RE, Barringer, TA, McGuire, DK & Peterson, ED 2014, 'A quantitative measure of diabetes risk in community practice impacts clinical decisions: The PREVAIL initiative', Nutrition, Metabolism and Cardiovascular Diseases, vol. 24, no. 4, pp. 400-407. https://doi.org/10.1016/j.numecd.2013.09.010
Shah, B. R. ; Cox, M. ; Inzucchi, S. E. ; Foody, J. M. ; Zimmer, L. O. ; Jorge, C. B. ; Ratner, R. E. ; Barringer, T. A. ; McGuire, Darren K ; Peterson, E. D. / A quantitative measure of diabetes risk in community practice impacts clinical decisions : The PREVAIL initiative. In: Nutrition, Metabolism and Cardiovascular Diseases. 2014 ; Vol. 24, No. 4. pp. 400-407.
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