Since 2015, the University of Michigan has offered the DPP at no out-of-pocket cost to its employees, dependents, and retirees with prediabetes (pDM). We assessed the yield of 3 proactive engagement strategies. In strategy A, 6,734 adults with no previous diagnosis of diabetes (DM) but with a claims diagnosis of pDM or A1c 5.7-6.4% were identified and mailed letters encouraging them to enroll in a DPP. In strategy B, 5,219 adults with no previous diagnosis of DM or pDM who were at high-risk for pDM or DM based on age, sex, and claims data on obesity, hypertension, and dyslipidemia were identified and mailed letters encouraging them to get an A1c test. In strategy C, 29,878 employees not targeted by strategies A or B were sent emails encouraging them to take an online risk test and, if positive, to get an A1c test. In general, individuals identified by strategies A and B were older, had higher BMIs, and were more likely to have cardiovascular (CV) risk factors or CV disease than those identified by strategy C. Of those targeted by strategy A, 649 (10%) enrolled in a DPP. Those who enrolled were more likely to be older, female, and to have a higher BMI than those who did not enroll. Of those targeted by strategies B and C, 1,402 (27%) and 3,768 (13%), respectively, had A1c tests or received new diagnoses of pDM or DM within 1-year of receiving the letter/email. In general, those who had A1c tests or were diagnosed with pDM or DM were more likely to be female, non-White, to have a higher BMI, and to have more CV risk factors or CV disease than those not tested or diagnosed. Of individuals tested in response to strategies B and C, 561 (40%) and 583 (15%) were diagnosed with pDM and 68 (12%) and 5 (1%) enrolled in a DPP. Together, these 3 complimentary strategies to encourage engagement in a DPP had a yield of 9% among individuals with pDM, which is substantially greater than the ∼0.0001% yield observed when passive strategies are employed, but not high enough to have a substantial impact on the population incidence of DM.
L.N. McEwen: None. K. Joiner: None. R. Bergmans: None. T.E. Hurst: None. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp.
National Institutes of Heath (1R01DK109995)