Diabetes prevention works. Here’s how to keep patients engaged.

Faced with rapidly growing prevalence of type 2 diabetes, physicians, health experts and communities are intensifying efforts to address this chronic condition that affects tens of millions of Americans. And that begins with identifying patients with prediabetes and referring them to a National Diabetes Prevention Program (DPP).

Offering a diabetes prevention program recognized by the Centers for Disease Control and Prevention has been a beacon of hope at an academic medical center in eastern North Carolina, giving patients the means to mitigate their risk and improve their overall well-being.

The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage their risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program lifestyle-change program based on their individual needs.

“Our patient population typically tends to be complex with multiple comorbidities. During a busy primary care clinic visit it is challenging to identify an at-risk patient and screen them for diabetes,” said Shiv Patil, MD, MPH. “Also, once a patient is diagnosed with prediabetes, there is not enough time to counsel them about diabetes prevention and referring them to a diabetes prevention program, especially if a referral order is not readily available in the electronic health record system.”

Dr. Patil is an assistant professor and director of research in the department of family medicine at the Brody School of Medicine, East Carolina University (ECU) in Greenville, North Carolina. He was appointed as one of the diabetes prevention physician champions for the state by the North Carolina Medical Society in collaboration with the AMA in 2021.

But “over the last year, our nutrition team worked with our organizational leadership to develop an electronic referral order to the DPP which is now available for providers,” Dr. Patil said. “It’s much easier and user-friendly and … has helped us increase the number of referrals and enrollment over the last year.”

Cohorts for the DPP started in 2017 at the ECU Family Medicine Center. The goal of this yearlong program is for each participant to reach 150 minutes of physical activity weekly, preventing or delaying type 2 diabetes and to lose 5–10% of their body weight. To date, 218 patients have participated in the program.

Here are some ways East Carolina University has improved their DPP to further reach patients with prediabetes to make appropriate lifestyle changes.

There is too often a drop-off in attendance, “especially in our maintenance phase because a lot of people do meet their goals in the intensive phase and think they don’t need to continue,” said Madison Sims, MS, diabetes prevention program coordinator at the ECU Family Medicine Center. To help with engagement, “one of the big things that we do in this program is give incentives. These incentives are given to them to help with the lifestyle change. So, we give them out based on what we’re learning.

“For example, we may be learning about finding time for fitness and we give them hand weights that are about three or five pounds. It’s just to help them be introduced to some other fitness areas,” Sims added. The goal is to “set them up for success and give them things that they are able to achieve.”

“We are an academic medical center, and we have a large family medicine residency program. We have 36 residents, more than 25 faculty and advanced practice providers here who work in our Family Medicine Center and hospital,” Dr. Patil said. “Since we started the program back in 2017, we have included diabetes prevention in our residents’ teaching curriculum.

When new residents begin in July, Dr. Patil and Kay Craven, MPH, nutrition services director and administrator of the diabetes prevention program at ECU, do a session discussing type 2 diabetes management, but also covering diabetes screening, prevention and the DPP. Dr. Patil and Craven also presented their diabetes prevention work at the department’s grand rounds in 2021 to educate health professionals about diabetes screening, prevention and the DPP.  

An ongoing challenge is “trying to reach our audience and make sure that the classes are culturally appropriate,” Craven said. “One of the things that we do is cooking classes, and we always encourage them to be a part of our cooking classes.”

“We’re really looking to how we can diversify each cohort by inviting speakers who might help reach our population as well as looking at foods and how we can make healthier foods within the culturally appropriate foods in our area,” she added.