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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: bimal.shah@duke.edu.
  • 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.

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 1.5 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).

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.

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

KEYWORDS:

Diabetes mellitus; Quality improvement; Risk prediction

PMID:
24374006
[PubMed - indexed for MEDLINE]
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