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

doi:10.1016/j.numecd.2013.09.010

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 journal › Article › peer-review

2 Scopus citations

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 language	English (US)
Pages (from-to)	400-407
Number of pages	8
Journal	Nutrition, Metabolism and Cardiovascular Diseases
Volume	24
Issue number	4
DOIs	https://doi.org/10.1016/j.numecd.2013.09.010
State	Published - Apr 2014

Keywords

Diabetes mellitus
Quality improvement
Risk prediction

ASJC Scopus subject areas

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

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10.1016/j.numecd.2013.09.010

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Shah, B. R., Cox, M., Inzucchi, S. E., Foody, J. M., Zimmer, L. O., Jorge, C. B., Ratner, R. E., Barringer, T. A., McGuire, D. K., & Peterson, E. D. (2014). A quantitative measure of diabetes risk in community practice impacts clinical decisions: The PREVAIL initiative. Nutrition, Metabolism and Cardiovascular Diseases, 24(4), 400-407. https://doi.org/10.1016/j.numecd.2013.09.010

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title = "A quantitative measure of diabetes risk in community practice impacts clinical decisions: The PREVAIL initiative",

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{\textregistered} (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.",

keywords = "Diabetes mellitus, Quality improvement, Risk prediction",

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

note = "Funding Information: This project was supported by an educational grant from Tethys Bioscience, Inc. The sponsor provided input on research design and reviewed the manuscript for accuracy and to ensure that no confidential information was disclosed. The Publications Committee (Eric Peterson, MD MPH, Chair; Silvio E. Inzucchi, MD; JoAnne M. Foody, MD; Carlos B. Jorge, MD; Robert E. Ratner, MD; Thomas A. Barringer, MD; and Darren K. McGuire, MD) collaborated in developing the research design and provided feedback on proposed analyses and drafts of the manuscript. Committee members were each paid for participation (<$10,000) for their work.",

year = "2014",

month = apr,

doi = "10.1016/j.numecd.2013.09.010",

language = "English (US)",

volume = "24",

pages = "400--407",

journal = "Nutrition, Metabolism and Cardiovascular Diseases",

issn = "0939-4753",

publisher = "Elsevier",

number = "4",

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T1 - A quantitative measure of diabetes risk in community practice impacts clinical decisions

T2 - The PREVAIL initiative

AU - Shah, B. R.

AU - Cox, M.

AU - Inzucchi, S. E.

AU - Foody, J. M.

AU - Zimmer, L. O.

AU - Jorge, C. B.

AU - Ratner, R. E.

AU - Barringer, T. A.

AU - McGuire, Darren K

AU - Peterson, E. D.

N1 - Funding Information: This project was supported by an educational grant from Tethys Bioscience, Inc. The sponsor provided input on research design and reviewed the manuscript for accuracy and to ensure that no confidential information was disclosed. The Publications Committee (Eric Peterson, MD MPH, Chair; Silvio E. Inzucchi, MD; JoAnne M. Foody, MD; Carlos B. Jorge, MD; Robert E. Ratner, MD; Thomas A. Barringer, MD; and Darren K. McGuire, MD) collaborated in developing the research design and provided feedback on proposed analyses and drafts of the manuscript. Committee members were each paid for participation (<$10,000) for their work.

PY - 2014/4

Y1 - 2014/4

N2 - 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.

AB - 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.

KW - Diabetes mellitus

KW - Quality improvement

KW - Risk prediction

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A quantitative measure of diabetes risk in community practice impacts clinical decisions: The PREVAIL initiative

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Keywords

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