The landmark 2002 Diabetes Prevention Program (DPP) Study showed that either an intensive lifestyle modification intervention program of diet and exercise or taking a medication called metformin greatly reduced diabetes risk in patients at high risk of developing diabetes, compared to “usual care.” The impact of this study was enormous. “Prediabetes” affects approximately one-third of adults in the United States.
Although the DPP study was published a decade ago, it is still unclear how to implement these potentially effective but costly programs in such a large population. This PCORI-funded study identified a way to focus these programs on patients who could benefit the most from the interventions. As part of a PCORI-funded evaluation looking at how the effects of medical treatments vary across patients, the researchers performed analyses on individual patient data from clinical trials, including a re-analysis of the DPP study. The project team’s published results from the DPP using risk predictive models, which take multiple patient characteristics into account at the same time, showed that a patient’s degree of benefit from metformin or from the lifestyle intervention was distributed very unevenly. Patients at low risk of developing diabetes received very little benefit from either intervention in terms of reduced diabetes incidence. However, patients at high risk benefited tremendously, and much more than reflected by the average trial results.
Health systems are confronted with a growing number of patients with prediabetes, but they lack the capacity to treat everyone. While there is a low risk of medical harm resulting from the lifestyle intervention, it is an extremely intensive undertaking for both the patient and the health system. The team’s research results provide valuable information to help providers and health systems prioritize patients most likely to benefit, such as those at especially high risk of developing diabetes. Yet to influence decision making, this information and risk model needs to be moved from the pages of the medical literature to the clinics and providers at the point of care.
The aim of this dissemination and implementation project is to incorporate the project team’s DPP benefit prediction model into an electronic health record (EHR)-based tool easily accessible at the point of care, adapting it as necessary using stakeholder input. In this way, the researchers will put into place a clear and clinically actionable understanding of the variation in the benefits of diabetes prevention interventions. The project team will also disseminate the EHR-based tool to approximately 50 clinic sites within two AMGA member healthcare provider organizations (Mercy Health Systems and Premier Medical Associates) and evaluate its use and effects.