Factors Influencing the Referral of Patients with Prediabetes to a Diabetes Prevention Program in the Bronx, New York.

Publisher: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion Country of Publication: United States NLM ID: 101205018 Publication Model: Electronic Cited Medium: Internet ISSN: 1545-1151 (Electronic) Linking ISSN: 15451151 NLM ISO Abbreviation: Prev Chronic Dis Subsets: MEDLINE

Original Publication: [Atlanta, Ga.] : U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, [2004]-

Diabetes Mellitus, Type 2*/epidemiology ; Diabetes Mellitus, Type 2*/etiology ; Diabetes Mellitus, Type 2*/prevention & control ; Prediabetic State*/complications ; Prediabetic State*/epidemiology ; Prediabetic State*/therapy ; Referral and Consultation*/statistics & numerical data ; Health Promotion*/statistics & numerical data; Female ; Humans ; Male ; Middle Aged ; Black People ; United States ; New York City ; Hispanic or Latino ; Adolescent ; Young Adult ; Adult ; White ; Socioeconomic Factors ; Black or African American

Introduction: Disparate engagement in the Diabetes Prevention Program (DPP) may occur as early as the point of referral for certain subgroups, including Black and Hispanic men. We aimed to determine patient demographic and provider characteristics associated with referrals to a health system DPP in the Bronx, New York.
Methods: Patient and health system characteristics for DPP-eligible patients seen in primary care between July 1, 2015, and December 31, 2017, were obtained through the electronic health record. Generalized mixed-effects modeling was used to test the association between referral rate and clinical and sociodemographic variables.
Results: Of 26,727 eligible patients, 66% were female, 46% were Hispanic, and 39% were non-Hispanic Black. Only 10% (n = 2,785) of eligible patients were referred to DPP. In the adjusted analyses, lower odds of referral were observed for men versus women (OR = 0.60; 95% CI, 0.52-0.66), for non-Hispanic White versus Hispanic patients (OR = 0.53; 95% CI, 0.40-0.71), and for uninsured patients versus Medicaid patients (OR = 0.66; 95% CI, 0.54-0.80). The odds were higher for patients in the highest versus lowest hemoglobin A1c (OR = 2.49; 95% CI, 2.27-2.72) category; for those in the highest versus lowest body mass index categories (OR = 1.61; 95% CI, 1.45-1.79); for middle-aged patients (aged 45-64 y) versus those aged 18-26 y (OR =1.63; 95% CI, 1.33-2.00); and for patients being seen by a family versus an internal medicine physician (OR = 1.65; 95% CI, 1.22-2.22).
Conclusion: We identified under-referral for men and highlighted other patient and health system factors associated with referral rates. Interventions to address bias in referrals and increase referrals for men at high risk for diabetes, not typically represented in DPP, are recommended.

Med Care Res Rev. 2011 Dec;68(6):650-66. (PMID: 21680578)
Prev Chronic Dis. 2019 Jun 27;16:E82. (PMID: 31255186)
J Gen Intern Med. 2019 Nov;34(11):2475-2481. (PMID: 31502095)
Popul Health Manag. 2017 Aug;20(4):262-270. (PMID: 28075695)
JAMIA Open. 2021 Nov 30;4(4):ooab101. (PMID: 34870108)
Diabetes Educ. 2020 Dec;46(6):580-586. (PMID: 33063641)
J Am Board Fam Med. 2019 Mar-Apr;32(2):209-217. (PMID: 30850457)
Am J Mens Health. 2018 Jul;12(4):998-1006. (PMID: 29540131)
Diabetes Care. 2017 Oct;40(10):1331-1341. (PMID: 28500215)
Curr Diab Rep. 2020 Feb 20;20(3):9. (PMID: 32080770)
Prev Chronic Dis. 2017 Mar 30;14:E28. (PMID: 28358669)
Diabetes Educ. 2019 Dec;45(6):616-628. (PMID: 31608798)
Health Educ Behav. 2022 Aug;49(4):647-657. (PMID: 34053326)
Am J Prev Med. 2018 Aug;55(2):e39-e47. (PMID: 29934016)
JAMA Netw Open. 2019 May 3;2(5):e193160. (PMID: 31074808)
MMWR Morb Mortal Wkly Rep. 2021 Aug 13;70(32):1075-1080. (PMID: 34383729)
Prev Sci. 2015 Jan;16(1):41-52. (PMID: 24384689)
Am J Manag Care. 2018 Oct;24(10):475-478. (PMID: 30325189)
Diabetes Care. 2020 Jan;43(Suppl 1):S14-S31. (PMID: 31862745)
Am J Health Promot. 2022 Feb;36(2):236-247. (PMID: 34844441)
J Clin Epidemiol. 2006 Mar;59(3):265-73. (PMID: 16488357)
Ann Intern Med. 2015 Dec 1;163(11):861-8. (PMID: 26501513)
Am J Prev Med. 2019 Mar;56(3):452-457. (PMID: 30661888)
Diabetes Metab Syndr Obes. 2020 Aug 19;13:2949-2957. (PMID: 32903871)
N Engl J Med. 2002 Feb 7;346(6):393-403. (PMID: 11832527)
J Gen Intern Med. 2022 Jan;37(1):15-22. (PMID: 33826060)

K12 TR004411 United States TR NCATS NIH HHS; KL2 TR002558 United States TR NCATS NIH HHS; P30 DK111022 United States DK NIDDK NIH HHS; R01 DK121896 United States DK NIDDK NIH HHS

Date Created: 20230921 Date Completed: 20231005 Latest Revision: 20240712

20240712

PMC10516205

10.5888/pcd20.230072

37733951