START Diabetes Prevention: A Multi-Level Strategy for Primary Care Clinics.

Area of Science:

• Primary care interventions
• Diabetes prevention
• Public health

Background:

• Prediabetes affects over a third of US adults, yet fewer than 5% receive treatment.
• Existing interventions often overlook clinician and system-level barriers to prediabetes care.

Purpose of the Study:

• To evaluate the effectiveness of a multi-level intervention on increasing prediabetes treatment uptake within a primary care setting.

Main Methods:

• A pragmatic study of the START (Screen, Test, Act, Refer and Treat) Diabetes Prevention intervention was conducted over 12 months.
• The intervention involved a structured workflow, shared decision-making tools, and EHR clinical decision support.
• Uptake of prediabetes treatment was defined as DPP referral, metformin prescription, or MNT referral within 30 days of a primary care visit.

Main Results:

• Prediabetes treatment uptake was significantly higher in the intervention clinic (11.6%) compared to the control clinic (6.7%, p<0.001).
• Patients in the intervention group reported more discussions about prediabetes with their clinicians (60% vs. 48%, p=0.002).
• Clinicians found the START intervention acceptable and useful, with enhanced patient understanding and engagement.

Conclusions:

• A low-touch, multi-level intervention effectively increases prediabetes treatment uptake in primary care.
• The intervention demonstrated feasibility and acceptability for clinicians.
• Enhanced patient understanding and communication regarding prediabetes were observed.