South Carolina might not be ground zero for the diabetes epidemic in the U.S., but it is not far behind. Its 13.7% prevalence of type 2 diabetes is well above the national rate of 11.3% and 44th—meaning very nearly the worst—out of the 50 states.
And where there is diabetes, surely there is prediabetes too. That is because the number of adults in the U.S. with prediabetes is almost three times higher than the number with diabetes. But there’s good news for any health system looking to put the brakes on this scourge of public health: The Centers for Disease Control and Prevention-recognized Diabetes Prevention Program focused on lifestyle change can reduce the risk of developing type 2 diabetes by more than 50%.
An AMA Insight Network Meeting highlighted how Prisma Health, the largest health system in South Carolina with nearly 600 primary care physicians, implemented a clinical operating system to help identify patients with prediabetes and enroll them in the health system’s diabetes-prevention programs.
The AMA Insight Network helps AMA Health System Program members gain early access to innovative ideas, get feedback from their peers, network and learn about pilot opportunities. Learn more.
It starts in the community
“It seemed like a no-brainer for us as a health care system,” said Peter Tilkemeier, MD, MMM, chair of Prisma Health’s medicine department. “If we're going to prevent future spend and approach this from an overall community health [and] wellness perspective, focusing on diabetes prevention was where we needed to be.”
The key to this, Dr. Tilkemeier noted, was meeting patients where they were, instead of requiring patients to find a local Prisma site. This meant working in churches and community centers and with nearby Clemson University through its extension offices.
“The farm extension is a place you go when your crops won't grow,” he said, noting that those offices have recently expanded to cover public health. “It's the place in the rural communities where we don't have primary care that we can get trusted individuals to deliver care.”
Then it’s backed up by technology
“A typical approach in a large health system towards improvement is where there are parallel structures in place for the management of the various domains of outcomes,” said Jonathan Gleason, MD, noting that safety, quality, experience, health equity, cost, efficiency and population health might all be pursued independently.
“We look at all these things as different sides of the same coin of better care,” said Dr. Gleason, Prisma Health’s executive vice president and chief clinical officer. He noted that Prisma’s clinical operating system, dubbed Pulse, prioritizes actionable insights in the workflow. “We bring it all together within one operating system,” so no information—including alerts and reminders and other demands on their time—gets to the care team member without first going through the operating system.
Results have an impact on agency
Rolling out the clinical operating system at its primary care offices helped to achieve several vital results. For example, from 2019 to 2023, Prisma enrolled 1,085 patients in 56 diabetes-prevention program cohorts and had a 74.5% retention rate. Compare this with the national diabetes-prevention program retention rate of 30% after 10 months.
In addition, Prisma patients enrolled in the diabetes-prevention program saw an average reduction in HbA1c from 6% to 5.6%.
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.
