Diabetes prevention is crucial for reducing the public health burden of diabetes in the United States. 84 million U.S. adults have prediabetes but 90% are undiagnosed. The NIH has prioritized finding efficient ways to translate outcomes achieved in diabetes prevention trials into routine healthcare practice. The National Diabetes Prevention Program recognizes lifestyle change programs meeting specific metrics that help prevent or delay diabetes. However, an effective model for engaging health systems and primary care providers in facilitating screening, testing and referral to these programs is lacking. There is currently no systematic approach to prediabetes management in the primary care setting, but it is essential for addressing the burden of diabetes. To address this need, we propose the following interrelated Specific Aims: 1) To conduct a retrospective cohort study to describe longitudinal primary care provider practices around the diagnosis and treatment of prediabetes using a linked claims and electronic medical record (EMR) dataset, 2) To conduct key informant interviews with stakeholders relevant to diabetes prevention, including leadership from health care system/clinics, insurance plan leaders, providers and patients, to identify barriers and facilitators to implementation, 3) To design and pilot test the diabetes prevention clinical pathway within a primary care clinic in Baltimore, MD, and evaluate its effectiveness on provider screening and intervention, and patient engagement in diabetes prevention over a period of 12 months. Dr. Eva Tseng is an Assistant Professor in the Division of General Internal Medicine and a clinical researcher at The Johns Hopkins University School of Medicine. Her long-term career goal is to become an independent clinician-investigator conducting pragmatic intervention studies with a focus on improving the prevention of diabetes in primary care. The proposed career development plan includes didactic and research training activities that will substantially build her skills in developing and implementing an intervention. These will include training in implementation science, clinical trial methods, quantitative data analytic methods for large claims/EMR databases, as well as qualitative data collection and analytic methods. This training will occur in the rich training environment of the Johns Hopkins Medical Institutions, including the Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research. She will receive guidance from her outstanding team of mentors and advisors with expertise in the methodologies needed for conducting the planned research, and a track record of mentoring and funding. The award and protected time will allow Dr. Tseng to build an independent NIH-funded research career and become a leader in pragmatic approaches to improve the prevention of diabetes in primary care with potential applications to other chronic diseases.

Public Health Relevance

84 million adults in the U.S. have prediabetes, a condition that increases the risk of diabetes and diabetes complications greatly. Research from our team and others has shown that prediabetes is underdiagnosed and that many primary care providers are unaware of evidence-based recommendations for the management of prediabetes. With this proposal, we will evaluate the longitudinal practices of primary care providers in managing prediabetes, engage key informants at multiple levels to identify barriers and facilitators, and design and pilot test a diabetes prevention clinical pathway within a primary care clinic in Baltimore, MD.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK)
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Spain, Lisa M
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Johns Hopkins University
Schools of Medicine
United States
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