Diabetes Prevention Services Research Articles

Real-world impacts from a decade of Quality Enhancement Research Initiative-partnered projects to translate the Diabetes Prevention Program in the Veterans Health Administration.

To describe the impacts of four Veterans Health Administration (VA) Quality Enhancement Research Initiative (QUERI) projects implementing an evidence-based lifestyle intervention known as the Diabetes Prevention Program (DPP). 2012-2024 VA administrative and survey data. This is a summary of findings and impacts from four effectiveness-implementation projects focused on in-person and/or online DPP across VA sites. Patient demographics, participation data, and key findings and impacts were summarized across reports from the VA Diabetes-Mellitus Quality Enhancement Research Initiative (QUERI-DM) Diabetes Prevention Program (VA DPP) Trial, QUERI-DM Online DPP Trial, the Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) QUERI DPP Project, and EMPOWER 2.0 QUERI Program. Between 2012 and 2024, four VA QUERI studies enrolled 963 Veterans in DPP across 16 VA sites. All participants had overweight/obesity with one additional risk factor for type 2 diabetes (i.e., prediabetes, elevated risk score, or history of gestational diabetes) and 56% (N = 536) were women. In addition to enhancing the reach of and engagement in diabetes prevention services among Veterans, these projects resulted in three key impacts as follows: (1) informing the national redesign of VA MOVE! including recommendations to increase the number of MOVE! sessions and revise guidelines across 150+ VA sites, (2) enhancing the national evidence base to support online DPP delivery options with citations in national care guidelines outside VA, and (3) demonstrating the importance of gender-tailoring of preventive care services by and for women Veterans to enhance engagement in preventive services. Over the past decade, the evolution of VA QUERI DPP projects increased the reach of and engagement in diabetes prevention services among Veterans, including women Veterans who have been harder to engage in lifestyle change programs in VA, and resulted in three key impacts informing type 2 diabetes and obesity prevention efforts within and outside of VA.

Public health insurance: An approach to mitigate the burden of diabetes in low resource settings

Background: Diabetes mellitus is a significant public health concern globally as well as in Owerri, Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin levels greater than 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking on specific risk factors associated with poor glycemic control among diabetes mellitus patients in Owerri. There is a gap in the literature regarding the association between health insurance and glycemic control in diabetic patients in Owerri. With health insurance assuming a significant position in healthcare service delivery in Nigeria, addressing this gap is valuable. Methods: We performed a cross-sectional study of health insurance as a determinant of glycemic control among 160 type 2 diabetic patients attending the family medicine clinic at the Federal University Teaching Hospital, formerly the Federal Medical Center, Owerri. Participants were measured as not insured, insured-private, and insured-public/National Health Insurance Scheme. The dependent variable was glycemic control measured using glycosylated hemoglobin. We used ecosocial theory as the theoretical framework of this research. SPSS was used for data analysis; multiple logistic regression was applied to assess the association between insurance status and glycemic control in the participants. Results:In the patients without health insurance coverage, the prevalence of poor glycemic control was 93.8% whereas in those with health insurance coverage, the prevalence was 60.0%. Logistic regression analysis showed that lack of access to health insurance was a determinant of glycemic control, with uninsured subjects at 28 times and 6 times increased risk of poor glycemic control compared with insured-private and insured-public subjects, respectively. Conclusion: We have shown in our study that insured enrollees have an increased likelihood of good glycemic control relative to uninsured subjects. This finding has the potential to promote positive social change through optimization of the National Health Insurance Scheme. Enabling regulations and designing policies to explicitly cover diabetes preventive and control services in the scheme could lead to improved glycemic control, and, thus, reduce the burden of the disease.

State health departments leverage pharmacy partnerships across the nation to advance diabetes care initiatives

BackgroundIn 2018, the Centers for Disease Control and Prevention (CDC)’s Division of Diabetes Translation (DDT) initiated a 5-year cooperative agreement funding opportunity with departments of health in every state and the District of Columbia. The funded recipients pursued activities that strengthened diabetes management and type 2 diabetes prevention interventions within their jurisdictions. An option to involve the pharmacy sector in their diabetes-related interventions was available. ObjectivesThis research aims to understand who public health departments partnered with in the pharmacy sector and identify the types of activities pursued together to expand access to diabetes-related interventions. MethodsA review of annual work plans and progress reports submitted to CDC by recipients during the first 4 years of the funding cycle was conducted. Descriptions of work conducted in partnership with pharmacies, pharmacists, or pharmacy organizations were flagged for review, coding, and analysis. ResultsOf the 51 public health department recipients, 48 collaborated with pharmacy partners within their jurisdictions. Activities were developed and carried out in ways that utilized the pharmacy workforce to support public health diabetes initiatives, such as the development and delivery of diabetes self-management education and support and type 2 diabetes prevention programs in pharmacies (68.8%), delivery of diabetes-related training for the pharmacy workforce (91.7%), and support of billing and sustainability efforts for pharmacy-based diabetes services (52.1%). ConclusionState public health department diabetes program personnel cultivated productive relationships with a variety of members of the pharmacy workforce. Through these partnerships, they leveraged one another's resources, expertise, and mutual determination to prepare and carry out diabetes-related interventions within their states. This document provides pharmacists and pharmacy decision-makers with foundational knowledge that can lead to increased engagement with public health partners to expand diabetes management and prevention services in pharmacy settings.

Defeating diabetes in the desert: A community-based mHealth diabetes screening intervention in Jodhpur Rajasthan.

There is a paucity of demonstrated models for mHealth-based diabetes screening and coordinated care in India, especially in western Rajasthan, which is the part of Thar desert. JSPH collaboratively developed and implemented an easy-to-use, noninvasive, mobile phone-based screening interview, to identify adults at high risk for diabetes. The high risk for diabetes was defined using multiple clinical and epidemiologic criteria, all based on the evidence for India and globally. Since participants above 35 years or older were only considered in the screening, the application was designed to categorize the participants as high and low risk. Out of 4000 screened participants, the percentage of males and females were 51% and 50%, respectively. Participants found to be at high risk and low risk were n = 3600 (90%) and 400 (10%). The mean age of high- and low-risk participants was 52.2 (+12.8) and 36.2 (+4.2), respectively. Of the 3600 high-risk individuals who have been given a follow-up interview, 90.50% of high-risk individuals obtained diabetes testing, and of these, 65.67% had a written report showing they test positive for diabetes or prediabetes, requiring ongoing clinical care. JSPH mHealth application provided a novel noninvasive way to better identify those at high diabetes risk in the community and demonstrated how to optimize the use of mobile health methods in diabetes prevention and care services.

Weight Loss in a Digital Diabetes Prevention Program for People in Health Professional Shortage and Rural Areas.

Individuals with prediabetes living in hard-to-reach and underserved areas experience barriers to accessing traditional in-person preventive health services. The National Diabetes Prevention Program (DPP) is a preventive health care program designed to reduce the risk of developing type 2 diabetes. Although there have been increasing numbers of remote DPPs accessible, there are little data on the clinical outcomes of digital DPPs for members living in hard-to-reach and underserved areas. This study assessed whether living in a designated Health Professional Shortage Area (HPSA) and a rural versus urban area impacted the weight loss of N = 7266 members of a fully digital program called Lark DPP. Secondary analyses included between-group comparisons of program retention and member characteristics, demographics, and socioeconomics. Percent weight loss did not differ by HPSA (P = 0.16) or rural/urban status (P = 0.15), despite greater potential barriers for members residing in HPSAs (eg, highest starting body mass index, lowest income, lowest education). Mean percent weight loss for members residing in an HPSA and rural area was mean (M) = 4.75%, standard error (SE) = 0.09; for members in a non-HPSA, rural area M = 4.96%, SE = 0.16; for members in an HPSA, urban area M = 4.55%, SE = 0.13; and for members in a non-HPSA, urban area M = 4.77%, SE = 0.13. Members of a fully digital DPP achieved weight loss that did not differ by HPSA or urban/rural designation. Fully digital programs offer a solution to reduce the risk of type 2 diabetes in areas where residents may not otherwise have access to diabetes prevention services.

Theory-informed strategies to address factors anticipated to influence implementation and people's participation in community pharmacy-based diabetes prevention services

BackgroundEarly identification of non-diabetic hyperglycaemia and implementation of diet and lifestyle changes can prevent type 2 diabetes. However, low participation in diabetes prevention services remains a problem in the UK. The community pharmacy, one of the most accessible healthcare settings in the UK, could provide one solution to improving participation. AimTo prioritize factors that could influence delivery of, and people-participation in, community pharmacy-based diabetes prevention services, and to identify strategies to facilitate successful implementation. MethodsA mixed-methods, primary care-based study, comprising of two stages: 1- Prioritizing key influences of participation and delivery using a structured Nominal Group Technique with people with non-diabetic hyperglycemia, and other stakeholders; 2 – Identifying theory informed strategies to facilitate successful implementation using framework analysis. This involved mapping prioritized influences and qualitative data from the Nominal Group Technique onto the Behaviour Change Wheel theoretical framework. The study was conducted in February 2019, in Norfolk, UK and ethical approval obtained prior to research commencing. ResultsFifteen participants (five people with non-diabetic hyperglycaemia, nine community pharmacy and general practice staff and one commissioner) participated. Participants prioritized “awareness” and “service integration” as key factors likely to influence participation and “the provision of information about health consequences e.g., leaflets” and “action planning e.g. general practice referral of patients to prevention services” as key strategies to facilitate participation. “Training”, “staffing levels” and “workload” were amongst the key factors prioritized as most likely to influence delivery. Strategies identified to facilitate implementation included “instructions of how to perform the behaviour e.g. standard operating procedures” and “reward e.g. funding”. ConclusionsThis research provides theory informed strategies needed to facilitate successful implementation of community pharmacy-based diabetes prevention services. The findings of this study should inform the design of future diabetes prevention services to ensure participation and sustainability.

The Role Of The Diabetes Specialist Team In The Modern Management Of Diabetes Mellitus: A Call For Its Implementation In Ghana

Many chronic illnesses require patient-centred care where behavioural change aimed at dealing and coping with the socio-psychological as well as the physical impact of the disease is emphasized.
 Diabetes presents such a challenge especially in the developing world where both human and material resources are limited in dealing with this complex disease. Most centres in Ghana and Africa in general, rely on overburdened practitioners who have responsibilities to other acute and chronic illnesses in addition to diabetes care.
 The Diabetes Specialist Team (DST) has become a tool in overcoming these complexities to improve care and outcomes. They work in a team with specialised and sometimes overlapping skills. Core members include Consultant physician diabetologists, specialist diabetes nurses, podiatrists, dieticians and clinical psychologists.
 The positive impact of DST is noticed in the aspects of diabetes preventive services, early diagnosis, patient education, medication use, risk factor and complication identification and management, together with in-patient care and management of special groups.
 Recognising that the needs of persons living with diabetes are under served, coupled with the fact that developing countries are expected to experience the greatest burden in terms of numbers and complications of diabetes, more resources are needed to reverse these expected grim statistics. Efforts should be made to develop and deploy DST as much as possible to provide specialised and dedicated services in the routine management of diabetes at least at the district or municipal health level. Resources are needed to maintain and snowball the impact of this approach.

Doubled-Up Households, Self-Management Behaviors, Diabetes Preventive Care Services, and Hospital Use in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) 2015-2020.

We investigated associations of living in a doubled-up household (i.e., adults living with adult children, other related adults, or other unrelated adults) with diabetes self-management behaviors, occurrence of diabetes preventive care services, and hospital use by Hispanic/Latino adults with diabetes. We analyzed data from the second clinical visit (2014-2017) through subsequent annual follow-up interviews completed through January 2020 of all participants with diabetes in the Hispanic Community Health Study/Study of Latinos. Multivariable regression was used to test associations between doubled-up status with diabetes self-management behaviors (i.e., checking blood glucose level, checking feet for sores), diabetes preventive care services done by a doctor (i.e., dilated-eye examination, feet checked, hemoglobin A1c measured, urine analysis for kidney function), and hospital use (i.e., emergency department [ED] visits and hospitalizations). Hispanic/Latino adults living doubled up were less likely to have their urine checked by a doctor for kidney disease compared with adults not in doubled-up households. Doubled-up status was not associated with diabetes self-management behaviors. Adults living doubled up in a household with other related adults had a 33% increased risk of ED visits compared with adults living doubled up in a household with adult children. Health care settings where Hispanic/Latino adults with diabetes receive trusted care should add housing characteristics such as doubled-up status to social-needs screening to identify residents in need of connecting with housing or social services and more targeted diabetes management services.

Diabetes care and prevention services provided by pharmacists: Progress made during the COVID-19 pandemic and the need for additional efforts in the post-pandemic era

Diabetes is a challenging metabolic disease that significantly impacts people's health worldwide. It requires a comprehensive approach for better prevention and control, especially during challenging times such as the recent pandemic. The COVID-19 pandemic has altered how health care professionals, including pharmacists, provide health care. With the widespread use of virtual and online platforms for service delivery, pharmacist-led diabetes care has been transformed to meet the needs of patients during the pandemic. This article aims to discuss examples of pharmacist-led diabetes care services during the pandemic and highlight areas where additional pharmacist efforts are needed in the post-pandemic era.

Translating the Diabetes Prevention Program Lifestyle Intervention to the Military Setting.

Diabetes and obesity pose a significant burden for the U.S. military beneficiary population, creating a great need to provide evidence-based diabetes and obesity prevention services for military personnel, retirees, and their dependents. Despite increasing dissemination of the Diabetes Prevention Program (DPP) lifestyle intervention nationwide, formal evaluation of implementation of this highly successful program is limited in the military setting. The purpose of this study is to prospectively evaluate delivery of a direct adaptation of a 1-year DPP lifestyle intervention at a U.S. Air Force medical facility, Wright-Patterson Medical Center (WPMC), to determine the feasibility of delivery of the program in a group of at-risk active duty military, retirees, and family members, as well as assess effectiveness in improving weight and other risk factors for type 2 diabetes. A pre/post study design was utilized to evaluate feasibility and effectiveness of the DPP Group Lifestyle Balance (GLB), an up-to-date, 22-session direct adaptation of the DPP curriculum, at WPMC. Participants chose to complete the 1-year program either in coach-led face-to-face groups or via DVD with weekly telephonic coach contact. The study was approved by the University of Pittsburgh and WPMC Institutional Review Boards. A total of 99 individuals enrolled in the study, with 83 (84%) and 77 (78%) completing 6- and 12-month follow-up assessments, respectively. The mean age of participants at baseline was 57 (range 20-85 years), with 63% being female. The group was comprised of individuals who were non-Hispanic White (73.7%), non-Hispanic Black (18.2%), and other race or Hispanic ethnicity (8.1%). Within this group, there were 10 active duty military, 37 retirees, and 52 family members. The DPP-GLB program was shown to be feasible to implement in this military healthcare setting as demonstrated by the high engagement over the course of the year-long program. Significant improvements were shown in the two main behavioral goals: mean weight (-12.8 lbs, -6.3%, P < .001) and mean physical activity (PA) (+18.9 Met-hrs/wk, P < .001). In addition, significant improvements in other diabetes and cardiovascular risk factors including low-density lipoprotein cholesterol, fasting insulin, diastolic blood pressure, and waist circumference were noted, as well as improvement in health-related quality of life. These results demonstrate that the DPP-GLB program delivered via face-to-face groups or DVD was feasible and effective in improving weight, PA levels, and diabetes and cardiovascular risk factors in this group of active and retired military personnel and their family members. The program was well received by the program participants as well as the WPMC team. These findings offer a model for provision of the DPP-GLB program throughout the Military Health System.

The "Ups and Downs" of Living With Type 2 Diabetes Among Working Adults in the Rural South.

The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults.

Evidence in Primary Prevention of Type 2 Diabetes Mellitus—What It Means for Primary Prevention of Type 2 Diabetes Mellitus Epidemic in Papua New Guinea

Type 2 diabetes is in epidemic proportion in Papua New Guinea. Although many people are at high-risk of developing diabetes, there is no diabetes prevention policy and services in Papua New Guinea to address this problem. A literature search was carried out to assess the available evidence in the primary prevention of type 2 diabetes mellitus among the population with pre-diabetes. The result shows that the primary preventative studies conducted on lifestyle modification and the use of metformin in prediabetes patients reduced overt type 2 diabetes mellitus. The application of the evidence in the prevention of the type 2 diabetes epidemic in Papua New Guinea, driven by a policy is feasible to address the diabetes epidemic.

Health Care Disparities in the Utilization of Type 2 Diabetes Prevention Services Among Ambulatory Care Patients in the United States

Background: Exercise routines, diet management, education and Medication Therapy Management (MTM) have shown to improve glycemic control, lower blood pressure and body weight. While the majority of patients are on some form of weight management, many do not receive professional guidance to create their diet plan. Objective: The aim of this study was to determine if the utilization of type 2 diabetes mellitus prevention services were impacted by patient and physician characteristics in visits to ambulatory providers in the United States. Findings: A total of 1,932 patients with a primary diagnosis of Type 2 Diabetes Mellitus were extracted from the 2017 National Ambulatory Medical Care Survey database, collected by the National Center of Health Statistics. The patients’ age, sex, race, gender, region, insurance and physician characteristics were among the demographic variables studied. The prevalence of lifestyle preventive services, including exercise therapy, nutrition therapy, patient education or counseling, were analyzed. Patients older than 61 years and white patients were offered more exercise therapy than their comparable demographics. The southern region of the U.S. and patients with Medicaid or state insured plans were offered and utilized the most exercise therapy, nutrition therapy and education. Family practice physicians and internists defined as primary care physicians offered the most exercise therapy, nutrition therapy and education services. Majority of the studied population were not offered exercise therapy, nutrition therapy, or education services, indicating the need for more preventative lifestyle services. Conclusions: Overall, the findings of this study revealed that there was a significant difference in the utilization and offering of preventive resources amongst various demographic groups and physician characteristics. This confirms the prevalence of disparities in the U.S. Healthcare System and calls for the need to narrow this gap both at the policy and community level.

Assessment of diabetes knowledge, screening and uptake of community diabetes programs in a peri-urban region in Australia

AimsThe Wollondilly Diabetes Program (WDP) is testing ways to improve uptake of diabetes prevention services. This project evaluated the reach of WDP in diabetes promotion while assessing diabetes knowledge and risk among residents. MethodsA WDP member travelled in the DW weekly to community events including outreach programs between October 2016 and June 2019. Data from diabetes knowledge questionnaire (DKQ), the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK), HbA1c and Random Blood Glucose (RBG) measurements obtained from participants who attended community events and road shows. ResultsOver the 32 months period, WDP attended 32 community events reaching 1415 people (∼3% of the Wollondilly adult population). DKQ was completed by 154 people (52.9% females, 78% Australian born, median age 69 years), 39% had diabetes and their mean score (25.0 ± 3.1, maximum possible score = 31) was similar to those without diabetes (24.0 ± 4.6, p = 0.093). AUSDRISK assessment was completed by 166 people with 85% at intermediate or high risk of diabetes. There were 65% results above range for RBG (≥5.5 mmol/l) and/or HbA1c (≥5.7%,39 mmol/mol). ConclusionA community outreach team set up in partnership with local stakeholders that offers opportunistic diabetes screening, is an effective way of engaging with the community to increase diabetes awareness and knowledge.

145-OR: Annual Wellness Visits Are Associated with Increased Use of Diabetes Preventive Services in the Diabetes Belt and Surrounding Counties

Background: The Affordable Care Act created annual wellness visits (AWVs) for Medicare beneficiaries to have one yearly visit to primary care physicians and discuss preventive care for the upcoming year. We assessed whether AWVs were associated with increased use of these preventive services in Medicare patients with diabetes living in the Diabetes Belt and surrounding counties. Methods: We used claims files from a longitudinal sample of ∼1,000,000 Medicare patients with diabetes living in the diabetes belt or surrounding counties, covering years 2014-2015. The Diabetes Belt was identified by the CDC as 644 counties across Appalachian and southeastern counties in the US that had diabetes prevalence ≥ 11% in 2008. We used these data to examine associations between AWVs and preventive service use in the next year. We examined four preventive services recommended annually for patients with diabetes by the ADA, including A1c tests, foot exam, eye exam, and microalbuminuria (MA) tests. Results: Of all patients, only 19.6% used AWVs in 2015. Eye exams (61% vs. 56%), foot exams (92% vs. 83%), A1C tests (78% vs. 73%), and MA tests (42% vs. 31%) were more common among patients who had an AWV in the preceding year compared with those who did not. These differences remained after adjusting for patient demographics, comorbidities, county level medical resources, and geographic factors: eye exam (Odds Ratio 1.13, 95% CI 1.12-1.15); A1c Test (1.28, CI 1.26-1.31); Foot Exam (2.06, CI 2.01-2.11); MA Test (1.45, CI 1.42-1.47). Conclusions: This study shows that AWVs were significantly associated with increased recommended preventive care use among patients with diabetes living in and near the diabetes belt. The low rates of AWV utilization by patients with diabetes in and around the Diabetes Belt is concerning and should receive more policy attention. Disclosure T. L. Mcmurry: None. S. Kim: None. J. M. Lobo: None. H. Kang: None. M. Sohn: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)

Community Pharmacy Engagement in Diabetes Prevention: Key Informant Interviews with Pharmacy Executives.

IntroductionEven though evidence-based diabetes prevention interventions exist, more than 1 in 3 Americans have prediabetes; the use of pharmacies has been explored as a way to reach and care for this population. The objective of this study was to analyze factors that influence adoption of type 2 diabetes prevention programs by community pharmacies.MethodsWe conducted 21 semistructured interviews in 2018 with decision makers from 11 independent pharmacies in 6 US states and the District of Columbia and from 10 chain pharmacies operating in 1 state, multiple states, and nationwide. We identified participants by using purposive sampling. We used qualitative methods to analyze data and conducted interviews until we reached saturation.ResultsMultiple themes emerged: 1) initiation of services is more likely if initial financial support is received; 2) patient demand for services, actual or perceived, is paramount; 3) diabetes prevention services often fit within the existing operations of a pharmacy and allow maximum use of resources; 4) customer loyalty is a clearly articulated advantage against competition; and 5) engagement in diabetes prevention affirms an expanded role and the value of pharmacies to serve communities.ConclusionPharmacies are well situated to deliver diabetes prevention programs to communities. Although considerable opportunity exists for pharmacies to address diabetes prevention, more could be done to reduce barriers to their use.

Pharmacist-Provided Diabetes Education and Management in a Diverse, Medically Underserved Population.

Diabetes prevalence continues to rise in the United States, affecting more than 30 million people (9.4% of the population) in 2015 (1). Diabetes is expensive in terms of both direct medical costs and indirect costs of disability, lost work productivity, and premature death. The estimated cost of diabetes in the United States was $245 billion in 2012 (2). Optimizing care by facilitating glycemic control, patient education, preventive health screenings, and adherence to the treatment regimen have been suggested as methods to decrease the cost of this disease (3). There are inequalities in the disease burden of diabetes in the United States. The prevalence, incidence, and complications rates of diabetes are higher in non-Hispanic black, Hispanic, and American Indian/Alaska Native populations (4,5). Minority, low-income, and uninsured people have a higher risk for omissions of recommended diabetes prevention services (6). Furthermore, people who are non-English–speaking may experience barriers to effective diabetes medication management, including prohibitive costs of medications, hindered communication, knowledge deficits, and difficulties in understanding (7). The American Diabetes Association consistently identifies the promotion of health equity for populations disparately affected by diabetes as an advocacy priority (8). Federally Qualified Health Centers (FQHCs) provide primary care, behavioral health services, dental care, and other health care services to medically underserved populations. These safety-net clinics work to reduce barriers to health and health care in low-income populations disproportionately affected by chronic disease by increasing access to health care providers and medications (9,10). In 2016, FQHCs provided care to more than 26 million patients, more than half of whom had an income below the federal poverty level. The Health Resources and Services Administration (HRSA) reported in its 2016 health center data report that 32.1% of the more than 2 million patients with diabetes receiving care at FQHCs had …

Identifying diabetes management opportunity areas in the USA

Using adherence to diabetes management guidelines as a case study, this paper applied a novel geospatial hot-spot and cold-spot methodology to identify priority counties to target interventions. Data for this...

The community pharmacy setting for diabetes prevention: A mixed methods study in people with 'pre-diabetes'.

Diabetes Prevention Programs (DPPs) comprising intensive lifestyle interventions may delay or even prevent the onset of type 2 diabetes in people with pre-diabetes. However, engagement with DPPs is variable with session times and transportation being reported amongst barriers; this may be addressed by community pharmacy (CP) involvement given its recognition for accessibility. To explore factors influencing engagement with the National Health Service (NHS) DPP and the role of CP in diabetes prevention. Nine hundred and sixty-two questionnaires were posted to people with pre-diabetes identified from five general practices in Norfolk, England between November 2017 and May 2018. Follow-up semi-structured interviews (n = 10) and a focus group (n = 6) were conducted with a sample of questionnaire respondents. Questionnaire data were analysed quantitatively using SPSS and qualitative data analysed inductively using thematic analysis. Themes relating to engagement and the role of CP in pre-diabetes were further analysed using the COM-B model of behaviour change. A total of 181 (18.8%) questionnaire responses were received, a quarter of whom reported to have either dropped out or declined attending the national DPP. DPP engagers were more likely to report the program location and session times as convenient. Community pharmacy was perceived as an acceptable setting for delivering diabetes prevention services (DPS) and a preferable alternative for regular pharmacy users and people with work and social commitments. Participants felt that opportunity to engage with CP DPS is enhanced by its accessibility and flexibility in making appointments. Knowledge about the DPS provided in CP and previous experience with CP services were central influences of capability and motivation to engage respectively. This research outlines factors that could influence engagement with community pharmacy-based DPS and provides evidence to inform intervention development. Further research would be required to determine the feasibility and cost-effectiveness of such interventions.

The community pharmacy setting for diabetes prevention: Views and perceptions of stakeholders.

BackgroundDiabetes prevention programmes delay or prevent the onset of type 2 diabetes in people with pre-diabetes. To increase accessibility, national guidelines recommend delivering diabetes prevention programmes in primary care settings, including community pharmacy. This study aimed to explore the English community pharmacy setting as an option for delivering diabetes prevention services.MethodsTwo focus groups and nine semi-structured interviews were conducted with stakeholders including, community pharmacists, general practitioners and commissioners. The topic guide was framed using the COM-B theoretical model for behaviour change to elicit practitioners’ capability, opportunity and motivation to engage with providing or referring to community pharmacy diabetes prevention services. Data were analysed thematically, and barriers/facilitators mapped to the COM-B framework.ResultsFive themes were identified: ‘Pre-diabetes management and associated challenges’, ‘The community pharmacy setting’, ‘Awareness of community pharmacy services’, ‘Relationships and communication’ and ‘Delivery of community pharmacy services’. Community pharmacy was highlighted as an accessible setting for delivering screening and follow-on lifestyle interventions. Key factors for enhancing the capability of community pharmacy teams to deliver the interventions included training and appropriate use of skill mix. Delivering diabetes prevention services in collaboration with general practices was identified as key to the provision of integrated primary care services. Whilst financial incentives were identified as a motivating factor for delivery, service promotion to patients, public and healthcare professionals was perceived as crucial for enhancing engagement.ConclusionsThis research highlights a role for community pharmacy in diabetes prevention. New service models should seek to integrate community pharmacy services in primary care to facilitate patient engagement and better communication with general practices.