title: A quantitative measure of diabetes risk in community practice impacts clinical decisions: the PREVAIL initiative.
abstract: OBJECTIVE
  While predictive tools are being developed to identify those at highest risk for developing diabetes, little is known whether these assays affect clinical care.
  
  
  RESULTS
  Thirty sites who used the PreDx(®) (Tethys BioScience, Emeryville, CA) abstracted clinical information from baseline clinic visits prior to a PreDx test and from the most recent visit at time of abstraction. All visits occurred between May 2008-April 2011 (median follow-up 198 days, IQR 124-334). The primary analysis was the influence of the PreDx test (5-year diabetes prediction) on subsequent care; descriptive statistics were used to summarize baseline and follow-up variables. Overall 913 patients with 2 abstracted visits were included. Relative to baseline, median SBP decreased 1.5 mmHg (p = 0.039), DBP decreased 2 mmHg (p < 0.001), LDL-C decreased 4 mg/dL (p = 0.009), and HDL-C increased 2 mg/dL (p < 0.001) at follow-up. Behavioral or lifestyle counseling was not significantly different from baseline to follow-up (71.2% vs. 68.1% (p = 0.077), but BMI was lower by 0.2 kg/m(2) at follow up (p = 0.013). At follow-up, more patients were prescribed metformin (13.7% vs. 9.7%, p < 0.001). A higher PreDx score was significantly associated with metformin prescription (p = 0.0003), lifestyle counseling (p = 0.0099), and a lower BMI at follow-up (p = 0.007).
  
  
  CONCLUSIONS
  The use of a prognostic test in patients perceived to be high risk for diabetes was associated with a modest but significant increase in the prescription of metformin and lifestyle interventions and a reduction in BMI.
authors.affiliation: Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA. Electronic address: bimal.shah@duke.edu.
authors.forename: B R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cox
authors.affiliation: Section of Endocrinology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Inzucchi
authors.affiliation: Cardiovascular Wellness Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Foody
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA.
authors.forename: L O
authors.initials: LO
authors.lastname: Zimmer
authors.affiliation: Presbyterian Novant Heart & Wellness, Charlotte, NC, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Jorge
authors.affiliation: American Diabetes Association, Alexandria, VA, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Ratner
authors.affiliation: Presbyterian Novant Heart & Wellness, Charlotte, NC, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Barringer
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: Duke Clinical Research Institute, Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA.
authors.forename: E D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003153:Community Health Services; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000379:methods; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D008687:Metformin
keywords: Diabetes mellitus; Quality improvement; Risk prediction