Interdisciplinary speed dating augments diabetes self-management education and support to improve health outcomes.

OBJECTIVE: To determine if a novel interdisciplinary "speed-dating" clinic augments Diabetes Self-Management Education and Support (DSMES). METHODS: Adult patients with diabetes attended a DSMES class. Two weeks later patients attended an interdisciplinary clinic utilizing a "speed-dating" format during which they progressed through 5 stations hosted by different healthcare disciplines at 30-minute increments: physician, pharmacist, nurse/dietitian, case manager, and psychologist. Shared decision-making was utilized to identify mutually agreeable recommendations. Change in clinical outcomes were compared for DSMES-only attenders versus Dual-attendees; utilization of emergency department and hospital services were measured 12 months before and after attending the Speed Dating clinic. This analysis represents patients attending the program during 2016. RESULTS: Sixty-nine attended the DSMES class, 40 of whom followed-up in the "speed-dating" clinic (58% return rate). Attending the Speed Dating clinic improved A1C (p = 0.003) and LDL-C (p = 0.003) compared to the DSMES class alone. Comparatively, after attending the speed-dating clinic, patients had fewer emergency department (p = 0.366) and hospital admissions (p = 0.036), and shorter lengths of hospital stay (p = 0.030). CONCLUSIONS: The interdisciplinary "speed-dating" approach improved diabetes outcomes beyond DSMES alone and reduced utilization of hospital services. PRACTICE IMPLICATIONS: Patients should attend DSMES but also participate in an Interdisciplinary Speed Dating follow-up to further improve outcomes.

Comparison of 3 risk factor-based screening tools for the identification of prediabetes.

OBJECTIVE: To compare risk factor-based screening tools for identifying prediabetes. METHODS: Participants in an employer-based wellness program were tested for glycosylated hemoglobin (A1C) at a regularly scheduled appointment, and prediabetes risk factor information was collected. The likelihood of having prediabetes and the need for laboratory testing were determined based on 3 risk factor-based screening tools: the Prediabetes Screening Test (PST), Prediabetes Risk Test (PRT), and 2016 American Diabetes Association guidelines (ADA2016). The results from the screening tools were compared with those of the A1C test. The predictive ability of the PST, PRT, and ADA2016 were compared using logistic regression. Results were validated with data from a secondary population. RESULTS: Of the 3 risk factor-based tools examined, the PRT demonstrated the best combination of sensitivity and specificity for identifying prediabetes. From July 2016 to March 2017, 740 beneficiaries of an employer-sponsored wellness program had their A1C tested and provided risk factor information. The population prevalence of prediabetes was 9.3%. Analysis of a second independent population with a prediabetes prevalence of more than 50% of confirmed PRT's superiority despite differences in the calculated sensitivity and specificity for each population. CONCLUSION: Because PRT predicts prediabetes better than PST or ADA2016, it should be used preferentially.

Systematic Diabetes Screening Using Point-of-Care HbA1c Testing Facilitates Identification of Prediabetes.

This prospective longitudinal study compares diabetes screenings between standard practices vs systematically offered point-of-care (POC) hemoglobin A1c (HbA1c) tests in patients aged 45 years or older. Systematically screened participants (n = 164) identified 63% (n = 104) with unknown hyperglycemia and 53% (n = 88) in prediabetes. The standard practice (n = 324) screened 22% (n = 73), most commonly by blood glucose (96%); 8% (n = 6) and 33% (n = 24) were found to have diabetes and prediabetes, respectively. The association between screening outcome and screening method was statistically significant (P = 0.005) in favor of HbA1C HbA1c may be the most effective method to identify patients unknowingly living in hyperglycemia. Point-of-care tests further facilitate screening evaluation in a timely and feasible fashion.