Use and Impact of Type 2 Diabetes Prevention Interventions

Introduction: RCTs have found that type 2 diabetes can be prevented among high-risk individuals by metformin medication and evidence-based lifestyle change programs. The purpose of this study is to estimate the use of interventions to prevent type 2 diabetes in real-world clinical practice set-tings and determine the impact on diabetes-related clinical outcomes. Methods: The analysis performed in 2020 used 2010-2018 electronic health record data from 69,434 patients aged >= 18 years at high risk for type 2 diabetes in 2 health systems. The use and impact of prescribed metformin, lifestyle change program, bariatric surgery, and combinations of the 3 were examined. A subanalysis was performed to examine uptake and retention among patients referred to the National Diabetes Prevention Program. Results: Mean HbA1c values declined from before to after intervention for patients who were pre-scribed metformin (-0.067%; p < 0.001) or had bariatric surgery (-0.318%; p < 0.001). Among patients referred to the National Diabetes Prevention Program lifestyle change program, the type 2 diabetes postintervention incidence proportion was 14.0% for nonattendees, 12.8% for some attendance, and 7.5% for those who attended >= 4 sessions (p < 0.001). Among referred patients to the National Diabetes Prevention Program lifestyle change program, uptake was low (13% for 1-3 sessions, 15% for >= 4 sessions), especially among males and Hispanic patients. Conclusions: Findings suggest that metformin and bariatric surgery may improve HbA1c levels and that participation in the National Diabetes Prevention Program may reduce type 2 diabetes incidence. Efforts to increase the use of these interventions may have positive impacts on diabetes -related health outcomes. (C) 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.