AMA publications

Diabetes is a costly chronic condition in the United States. The incremental increase in costs of the disease can begin and accelerate prior to first diagnosis. This analysis finds that the incremental rise in costs of diabetes are shown to begin at least 5 years before diagnosis of the disease and accelerate immediately after diagnosis. Results of the matching model suggest that the newly diagnosed case subjects spent $8941 more than control subjects not diagnosed with diabetes over the span of 5 years, with approximately $4828 in the year of diagnosis. Results show that the rise in medical spending associated with diabetes begins well in advance of the first diabetes diagnosis and support the need to encourage physicians to implement timely identification and prevention efforts to reduce the economic burden of the disease.

The objective of this study was to determine if certified electronic health record technology (CEHRT) can be used to identify and refer patients with prediabetes to lifestyle change programs (LCPs) recognized by the National Diabetes Prevention Program (DPP). This pilot utilized a prediabetes registry, patient portal, and clinical decision support to increase referrals. The referral rate increased 7-fold compared to the baseline period, with high referral to enrollment conversion rates. CEHRT coupled with active provider engagement can serve as a tool to identify prediabetes patients and facilitate LCP referrals and enrollment.

The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. This framework can also be used for other chronic disease prevention strategies as well.  

The Prediabetes Clinical Quality Measures, developed by the AMA’s Prediabetes Measures Technical Expert Panel, are electronic clinical quality measures (eCQMs) that aim to identify and define new measures for prediabetes in an effort to support type 2 diabetes prevention efforts nationwide. Specific areas of focus include increasing screening and testing for prediabetes, referring/providing those at risk an intervention, and follow-up testing for patients with prediabetes.

The AMA partnered with the YMCA as part of a Centers for Medicare and Medicaid Innovation demonstration project to develop and test quality improvement strategies to implement routine screening, testing, and referral of Medicare patients with prediabetes to DPPs at local YMCAs. The study determined that EMR systems used to identify eligible patients via a registry referred more people to the YMCA DPP than practices that used a point-of-care method alone or practices that used a combination of methods. While all approaches showed increased enrollment, point-of-care methods were most successful.

Most primary care providers (PCPs) surveyed are unaware of the Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Program or the Prevent Diabetes STAT toolkit. While 97% of respondents tested patients for prediabetes, only 27% screened for it. Those familiar with the toolkit were nearly four times likelier to screen for prediabetes and refer to a lifestyle-change program, highlighting the need for greater awareness.

A recent study on prediabetes and medical expenditures confirms that preventing the onset of type 2 diabetes can reduce annual health care costs by thousands of dollars per patient and generate large positive returns on investment (ROI) for health systems, insurers and employers.