1244-P: Diabetes Screening to Appropriate Follow-Up: Are Patients Getting Timely Diagnoses and Treatment?

Objective: To measure time from positive diabetes screening test to appropriate follow-up action, i.e., diagnosis, pharmacologic treatment, or negative confirmatory test, using a large, geographically diverse clinical dataset.

Study Design: Retrospective descriptive analysis in a clinical database with over 25 million patient records.

Population Studied: From 2013-2017, 61,162 patients aged 18-75 from 23 health care organizations (HCOs) with ≥ 1 outpatient visit in last 12 months of data, a laboratory finding of HbA1c ≥ 6.5 or fasting plasma glucose (FPG) ≥ 126 in the last 12-24 months, and no prior diabetes diagnosis or prescriptions (except metformin).

Principal Findings: Positive diabetes tests were indicated by HbA1c (28%), FPG (61%), or both (11%). A total of 5.7% of patients had an FPG ≥ 200, and 6.9% had an HbA1c ≥ 8.0. Sixty-five percent (range 55-77% across 23 HCOs) had appropriate action in 3 months following a positive screening: 35% had a diagnosis or prescription for an antidiabetes medication; 30% had neither diagnosis nor prescription but had a subsequent negative diabetes test result. The remaining 35% had no diagnosis nor prescription, and either re-tested positive for diabetes or had no follow-up. By 12 months, 83% of all patients received appropriate follow-up. Among patients with HbA1c ≥ 8.0, 92% and 96% had appropriate follow-up within 3 and 12 months, respectively. Most initial prescriptions were for metformin (84%) with variation in use of 2nd or 3rd line diabetes medications: sulfonylurea, 1-12%; DPP-4, 0-10%; SGLT2, 0-10%; GLP-1, 0-3%; and insulin, 1-12%.

Conclusions: Within a year of a positive diabetes screen, most patients received appropriate action. Those with higher lab values were more likely to receive appropriate action sooner. Among those with prescriptions, most were for metformin. The proportion of patients with appropriate action, time to action, and type of action, e.g., use of 2nd and 3rd line agents, all varied considerably across HCOs.