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Nutr Metab Cardiovasc Dis. 2014 Apr;24(4):400-7. doi: 10.1016/j.numecd.2013.09.010. Epub 2013 Nov 1.

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

Author information

  • 1Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA. Electronic address:
  • 2Duke Clinical Research Institute, Duke University, Durham, NC, USA.
  • 3Section of Endocrinology, Yale University School of Medicine, New Haven, CT, USA.
  • 4Cardiovascular Wellness Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • 5University of North Carolina, Chapel Hill, NC, USA.
  • 6Presbyterian Novant Heart & Wellness, Charlotte, NC, USA.
  • 7American Diabetes Association, Alexandria, VA, USA.
  • 8University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • 9Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA.



While predictive tools are being developed to identify those at highest risk for developing diabetes, little is known whether these assays affect clinical care.


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 1.5 mmHg (p = 0.039), DBP decreased 2 mmHg (p < 0.001), LDL-C decreased 4 mg/dL (p = 0.009), and HDL-C increased 2 mg/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 0.2 kg/m(2) 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).


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.

Copyright © 2013 Elsevier B.V. All rights reserved.


Diabetes mellitus; Quality improvement; Risk prediction

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