Use of diabetes risk tool results in more favorable care decisions

January 14, 2014 – The DCRI’s Bimal Shah, MD, MBA, led the study of the PREVAIL initiative.

Patients at high risk of developing type 2 diabetes who receive a simple prognostic test are more likely than those who don’t undergo the test to receive clinical care that can prevent them from ever developing the disease.

That is the result of a new study by DCRI researchers Bimal Shah, MD, MBA (pictured); Margueritte Cox; Eric Peterson, MD, MPH; and colleagues from several other institutions. The study appears in the online edition of the journal Nutrition, Metabolism and Cardiovascular Diseases.

bimal-shah-archiveType 2 diabetes affects more than 25 million people in the United States and is responsible for more than $174 million in health care costs each year. To combat this growing epidemic, clinicians and researchers have developed a number of prognostic tools to identify patients at risk of developing the condition. A quality-improvement endeavor, the Provision of Evidence-based Therapies Among Individuals at High Risk for Type 2 Diabetes (PREVAIL) initiative, was designed to examine the influence of one such prognostic test (PreDx) on the application of interventions related to pre-diabetes and other risk factors, as well as to determine the quality of care received by patients at perceived risk of developing diabetes.

In this study, Shah and his colleagues obtained patient data from 30 sites across the country that used the PreDx test and participated in the PREVAIL initiative. These sites gathered information on the seven biomarkers that comprise the PreDx test (glucose, HbA1c [or glycated hemoglobin], insulin, high-sensitivity C-reactive protein, ferritin, adiponectin, and interleukin 2 receptor alpha). Those biomarkers are used to generate a score from 1.0 to 10.0, where 1.0 represents minimal risk of developing type 2 diabetes and 10.0 represents maximum risk.

These scores were also gathered for analysis, as was information on demographics, medical history, weight, blood pressure, body mass index, reasons for assessing the patient for diabetes risk, medications prescribed at time of visit, key laboratory values, and documentation of diabetes-risk-related counseling. Overall, the researchers studied data from 913 patients.

After conducting a statistical analysis, the researchers found that patients with perceived higher risk for diabetes were more likely to have improved cardiometabolic profiles at follow-up. There were no significant increases overall in the recommendations for lifestyle or behavioral modifications, but there were modest but statistically significant increases in the prescription of antihypertensives, lipid therapies, and metformin. Similarly, there were modest, significant reductions in blood pressure, lipid parameters, and body mass index from baseline to follow-up in all patients.

These findings, the researchers concluded, suggest that the PreDx test may have a favorable impact on clinical decisions that are important in the prevention of type 2 diabetes and should be investigated further.