Many patients who could benefit from intensive lifestyle interventions to reduce and prevent diabetes may not be getting the opportunity, according to researchers at Montefiore Health System (MHS).
Beginning in 2010, MHS partnered with the YMCA of Greater New York to provide the YMCA’s 1-year Diabetes Prevention Program (DPP) to patients in Bronx-based primary care clinics. During an office visit, eligible patients were told of their risk for developing diabetes and asked whether they were interested in participating. Physicians referred patients who said yes. Schedule and location for 16 core sessions were based on availability of coaches, space for the sessions, and patient demand.
Over the study period, 1,249 patients were referred to the DPP. For up to 1 year after referral, MHS placed patients in 66 core groups. “Placed” meant they were scheduled to attend a session. Patients who attended ≥ 3 sessions were considered “enrolled.” Of MHS patients referred to the YMCA’s DPP, only 34% were placed. Of those, 47% attended ≥ 3 sessions.
More than half (53%) of placed patients were never enrolled. But when they do enroll the study shows patients have good results. One-third of patients lost ≥ 5% of their body weight during their enrollment. The average weight loss was 3.4%.
The study points to some areas for improvement, the researchers say. Reducing the lag time between referral and the start of the sessions, for instance, would maximize the likelihood of enrollment. Patients who started their sessions within 2 months of their referral date were more often enrolled compared with those who had to wait ≥ 4 months (54% vs 22%). The researchers also note that the timing of referrals and sessions are important considerations, and efforts should be made to coordinate them.
Targeting younger patients and Spanish-speaking adults also would help. Attrition among younger participants is of “particular concern,” the researchers say, given that about 26% of adults aged < 60 years have prediabetes. Patients aged 18 to 44 years, the bulk of the patients referred, were least often placed compared with patients aged ≥ 45 years. Patients who preferred sessions in Spanish were less often placed than those who preferred English.
Finally, the researchers point out that health care providers have an important role in placing patients: The number of referrals that a provider made was associated with whether or not the patient was placed.