Communicating risk of diabetes to patients results in lower incidence at 1- and 3-year follow-up and improved preventive intervention

Objective One-third of American adults are estimated to have prediabetes but the vast majority are unaware. Accordingly, persons with prediabetes are equally unaware of their personal susceptibility of developing type 2 diabetes and the impact of weight loss on reducing the risk of progression. The primary aim of this study was to demonstrate that raising awareness of present risk, risk reduction, and offering available, accessible preventive interventions would result in fewer incidences of type 2 diabetes at 1- and 3-year follow-up periods. Secondary aims included clinician use of a novel diabetes risk calculator in primary care indicated by the proportion of patients being offered a preventive intervention. Methods In this single-arm study, persons with prediabetes from three primary care sites received a letter that communicated their personalized risk of progression to diabetes within three years; estimated risk reduction with 5, 10, 15% weight loss, reported in pounds, representing data illustrated in the diabetes risk calculator; and offered a choice of five free, 6-month, programs. Progression to type 2 diabetes was evaluated at 1- and 3-year follow-up periods using electronic health record data. Comparisons are made between the active participants and the non-respondent group. The diabetes risk calculator was implemented in 53 primary clinics in July 2020 and viewable in the electronic health record of persons with prediabetes without the need for clinician action. Electronic health record data were used to evaluate the rate of clinicians offering or referring persons with prediabetes to a preventive intervention—these rates of referral were compared between two phases (pre-implementation: 8/2019-2/2020; early implementation: 8/2020-2/2021). Results Persons with prediabetes (N=328) received letters and n=83 responded to the invitation to choose a preventive intervention (treatment). Follow-up data were available for n=55 treatment and n=169 non-respondents at 1- and 3-years. At 1-year follow-up, 2% of treatment and 20% of non-respondents developed type 2 diabetes (p<0.0001) and at 3-year follow-up, 25% of treatment and 42% of non-respondents developed diabetes (p=0.038). In the early implementation phase, N=8,771 persons had prediabetes, 0.4% received care, and 10.7% received a referral whereas in the pre-implementation phase, N=9,638 persons had prediabetes, 0.3% received care (p=0.088), and 9.7% were referred (p=0.029). Conclusion Progression to type 2 diabetes was halted at 1- and 3-year follow-up for a significantly higher proportion of persons who received diabetes risk calculator results and initiated a preventive intervention compared to those who did not. In the early implementation phase, clinicians referred a higher proportion of persons with prediabetes to preventive intervention when presented with diabetes risk calculator results as compared the pre-implementation period. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT05395377 ### Funding Statement This work was supported by the Geisinger Health Plan, Quality Fund Pilot Project Program. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Study procedures were reviewed and approved by the Geisinger Institutional Review Board (IRB# 2017-0394). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript