Opportunities to Reduce Diabetes Risk in Women of Reproductive Age: Assessment and Treatment of Prediabetes within a Large Integrated Delivery System

Abstract

BackgroundPreventing diabetes before pregnancy may be important to improve maternal and infant outcomes. Although the preconception period is a crucial time to focus on chronic disease prevention, little is known about preventive services for reproductive-aged women at risk of developing diabetes. MethodsUsing electronic health record data from patients at Kaiser Permanente Northern California, we identified 21,965 nonpregnant women aged 18 to 44 with incident prediabetes (PDM; fasting plasma glucose [FPG] = 100–125 or glycated hemoglobin A1c = 5.7%–6.4%) between 2007 and 2010. We looked for evidence of a “clinical response” to PDM in the 6 months after laboratory testing, defined as retesting of blood glucose levels, referral or attendance to health education, diagnosis of PDM, metformin initiation, or a clinical note of discussion of PDM. Multilevel models were used to examine the relationship between patient characteristics and clinical response, and to assess provider-level variation. ResultsFewer than one-half of women had a documented clinical response to the PDM-range laboratory result. Women with higher FPG values and body mass indexes were more likely to have a PDM diagnosis (FPG 120–125 vs. 100–119: OR, 1.96; 95% CI, 1.78–2.17; body mass index, 30–34 kg/m2 vs. <25 kg/m2: OR, 1.30; 95% CI, 1.13–1.48) and have ‘PDM’ recorded in the notes (FPG 120–125 vs. 100–119: OR, 1.15; 95% CI, 1.06–1.26; body mass index: 30–34 kg/m2 vs. <25 kg/m2: OR, 1.58; 95% CI, 1.44–1.74). Provider-level variation was modest, except for metformin initiation (intraclass correlation coefficient, 0.8; p < .01). ConclusionsLow clinical response to PDM among women of reproductive age suggests there are missed opportunities for diabetes prevention among this vulnerable population.