title: Implementation of a prediabetes identification algorithm for overweight and obese Veterans.
abstract: Type 2 diabetes prevention is an important national goal for the Veteran Health Administration (VHA): one in four Veterans has diabetes. We implemented a prediabetes identification algorithm to estimate prediabetes prevalence among overweight and obese Veterans at Department of Veterans Affairs (VA) medical centers (VAMCs) in preparation for the launch of a pragmatic study of Diabetes Prevention Program (DPP) delivery to Veterans with prediabetes. This project was embedded within the VA DPP Clinical Demonstration Project conducted in 2012 to 2015. Veterans who attended orientation sessions for an established VHA weight-loss program (MOVE!) were recruited from VAMCs with geographically and racially diverse populations using existing referral processes. Each site implemented and adapted the prediabetes identification algorithm to best fit their local clinical context. Sites relied on an existing referral process in which a prediabetes identification algorithm was implemented in parallel with existing clinical flow; this approach limited the number of overweight and obese Veterans who were assessed and screened. We evaluated 1,830 patients through chart reviews, interviews, and/or laboratory tests. In this cohort, our estimated prevalence rates for normal glycemic status, prediabetes, and diabetes were 29% (n = 530), 28% (n = 504), and 43% (n = 796), respectively. Implementation of targeted prediabetes identification programs requires careful consideration of how prediabetes assessment and screening will occur.
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.|Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Tannaz
authors.initials: T
authors.lastname: Moin
authors.affiliation: VA Center for Clinical Management Research, Ann Arbor, MI.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: VA Center for Clinical Management Research, Ann Arbor, MI.
authors.forename: Bradley
authors.initials: B
authors.lastname: Youles
authors.affiliation: VA Center for Clinical Management Research, Ann Arbor, MI.
authors.forename: Fatima
authors.initials: F
authors.lastname: Makki
authors.affiliation: Minneapolis VA Health Care System, Minneapolis, MN; and University of Minnesota Medical Center, Minneapolis, MN.
authors.forename: Charles
authors.initials: C
authors.lastname: Billington
authors.affiliation: Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC.
authors.forename: William
authors.initials: W
authors.lastname: Yancy
authors.affiliation: Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kinsinger
authors.affiliation: Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Weinreb
authors.affiliation: Baltimore VAMC, Baltimore, MD; and University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Nanette
authors.initials: N
authors.lastname: Steinle
authors.affiliation: VA Center for Clinical Management Research, Ann Arbor, MI.|Department of Family Medicine, University of Michigan, Ann Arbor, MI; and Diabetes Quality Enhancement Research Initiative (QUERI), VA, Ann Arbor, MI.
authors.forename: Caroline
authors.initials: C
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D011236:Prediabetic State / Q000175:diagnosis*; D015995:Prevalence; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: Veterans; diabetes; diabetes prevention; guidelines; health services research; implementation research; obesity; prediabetes; screening; weight management