Date on Paper

8-2022

Document Type

Doctoral Paper

Degree Name

D.N.P.

Department

Nursing

Committee Chair

Volpert, Elisabeth

Committee Member

Flint, Angela

Author's Keywords

kentucky; louisville; screening; prediabetes; type 2 diabetes; risk assessment

Abstract

Abstract

Background: Over one-third of the United States population, approximately 86 million individuals, are estimated to have prediabetes (CDC, 2021a). If left untreated, prediabetes will progress to type II diabetes mellitus (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop T2DM within their lifetime (Hostalek, 2019).

Purpose:The purpose of this quality improvement project was to implement and evaluate the American Diabetes Association MyChart Diabetes Risk Assessment tool in a primary care clinic to optimize the early identification of prediabetes and T2DM in non-pregnant adults ages 18 to 70 years.

Methods: Non-pregnant patients aged 18-70 years without a diagnosis of prediabetes or diabetes mellitus Type I or II were sent a web-based diabetes risk questionnaire. Data was collected via the electronic health record throughout implementation and analyzed using SPSS software by assessing five categories: (1) number of patients screened with the Diabetes Risk Assessment; (2) number of patients with a score ≥ 5 indicating a high risk for diabetes (3) age, sex, race, and BMI of all patients (4) number of patients referred for FPG or HbA1c if score ≥ 5 (5) number of patients with an abnormal FPG or HbA1c.

Intervention: This project's intervention was to send a Diabetes Risk Assessment via the electronic health record to all non-pregnant adults aged 18-70 years who do not have a diagnosis of prediabetes or diabetes mellitus Type I or II and have a routine medical appointment scheduled in February or March of 2022.

Results: During the five-week implementation period, 183 participants met inclusion criteria. Of the 183 participants included, 120 (66%) participants had an active MyChart account and were sent the American Diabetes Association MyChart Diabetes Risk Assessment questionnaire electronically. Of the 120 participants who were sent the questionnaire, 61 (51%) participants responded. Of the participants that responded, 37 (61%) were identified to be high-risk and 24 (39%) were found to be low-risk. Of the high-risk participants, 12 (32%) had an A1c, fasting plasma glucose, or both ordered. Of the 12 high-risk particpants with labs ordered, 7 had lab results in the prediabetic range (58%).

Discussion: The number of individuals unknowingly living with prediabetes or T2DM is substantial, and the risk of failing to treat the disease early is significant. Screening and educating patients regarding their risk for diabetes encourages self-efficacy in prevention and treatment. This project affirmed that using a researched and validated tool, like the ADA Diabetes Risk Assessment tool, was feasible and effective in identifying patients at risk for diabetes.

Keywords: screening; prevention; prediabetes; type 2 diabetes; risk assessment; obesity; evidence-based practice; screening protocols

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