Patterns of Diabetes Screening and Prediabetes Treatment during Office Visits in the US

Kayce M. Shealy; Jun Wu; Jessica Waites; Nancy A. Taylor; G. Blair Sarbacker

doi:10.3122/jabfm.2019.02.180259

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Figure 1.
Study sample of eligible visits with risk factors for prediabetes, NAMCS 2012–2015. CVD, cardiovascular disease; HTN, hypertension; PCOS, polycystic ovarian syndrome.
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Figure 2.
Trend of diabetes screening prevalence in the study sample (2012 to 2015).
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Figure 3.
Prevalence of laboratory testing provided or ordered for diabetes screening at the visits (n = 8375).
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Figure 4.
Treatment provided during visits with prediabetes (n = 5406).

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Table 1.

Characteristics of Visit Sample and Factors Associated with Diabetes Screening (n = 105,721)

Variable	Total No. (n = 105,721)	Diabetes Screening (n = 8,375), N (weighted %)	No Diabetes Screening (n = 97,346), N (weighted %)	Adjusted OR of Screening (95% CI)
Age (years)
18 to 44	5,845 (6.8)	653 (8.6)	5,192 (6.6)	1.00
45 to 64	52,100 (49.7)	4,302 (53.6)	47,798 (49.2)	1.18 (0.96–1.46)
≥65	47,776 (43.5)	3,420 (37.8)	44,356 (44.2)	0.86 (0.69–1.06)
Race
White	92,347 (83.8)	7,043 (78.2)	85,304 (84.5)	1.00
Black	9,263 (10.5)	918 (14.9)	8,345 (9.9)	1.28 (1.03–1.58)
Other^{^*}	4,111 (5.7)	414 (7.0)	3,697 (5.5)	1.44 (1.14–1.82)
Sex
Female	60,831 (58.5)	4,633 (56.9)	56,198 (58.7)	1.00
Male	44,890 (41.5)	3,742 (43.1)	41,148 (41.3)	0.99 (0.88–1.11)
BMI
<18.5	42,799 (36.1)	1,451 (13.1)	41,348 (39.1)	1.00
18.5 to 25	16,062 (16.4)	1,536 (19.8)	14,526 (15.9)	2.63 (2.15–3.21)
25 to 30	22,692 (23.6)	2,703 (36.3)	19,989 (21.9)	3.17 (2.63–3.81)
≥30	24,168 (24.0)	2,685 (30.7)	21,483 (23.1)	2.08 (1.72–2.51)
Primary payer
Private	46,101 (44.3)	4,085 (50.5)	42,016 (43.4)	1.00
Medicare/Medicaid	46,584 (43.4)	3,431 (40.3)	43,153 (43.8)	0.79 (0.69–0.91)
Uninsured	4,006 (4.6)	164 (1.9)	3,842 (5.0)	0.52 (0.37–0.73)
Other^†	9,030 (7.7)	695 (7.4)	8,335 (7.8)	0.87 (0.61–1.25)
Smoking	13,764 (12.8)	1,333 (15.7)	12,431 (12.5)	0.98 (0.87–1.10)
Comorbidity
Hypertension	36,729 (37.1)	4,512 (53.0)	32,217 (35.0)	1.05 (0.92–1.20)
CHF	3,365 (3.3)	365 (3.4)	3,000 (3.3)	0.75 (0.58–0.96)
CAD	4,996 (5.4)	740 (7.7)	4,256 (5.1)	0.97 (0.79–1.19)
PCOS	70 (0.08)	19 (0.2)	51 (0.1)	—^‡
Abnormal lipids^§	1,323 (1.3)	362 (3.2)	961 (1.1)	1.69 (1.30–2.20)
Prediabetes	5,406 (6.0)	1,523 (16.7)	3,883 (4.6)	2.56 (2.19–3.00)
Total no. of chronic conditions
0	34,527 (30.5)	1,241 (14.8)	33,286 (32.6)	1.00
1	32,263 (30.2)	2,102 (25.6)	30,161 (30.8)	1.56 (1.33–1.83)
2	20,470 (20.0)	2,362 (26.6)	18,108 (19.0)	2.26 (1.87–2.74)
>2	18,461 (19.4)	2,670 (33.0)	15,791 (17.6)	2.97 (2.37–3.72)
Physician Specialty
Family/Internal medicine	18,378 (29.3)	3,959 (62.8)	14,419 (24.8)	1.00
CVD specialty	3,730 (4.6)	520 (5.0)	3,210 (4.5)	0.38 (0.25–0.58)
Other	83,613 (66.0)	3,896 (32.2)	79,717 (70.7)	0.26 (0.22–0.31)
Physician Office
Metropolitan area	93,411 (91.7)	7,350 (92.3)	86,061 (91.6)	0.83 (0.67–1.03)
Region
Northeast	15,449 (21.5)	1,518 (27.5)	13,931 (20.7)	1.00
Midwest	28,363 (17.9)	2,207 (16.9)	26,156 (18.0)	0.61 (0.48–0.78)
South	37,030 (37.4)	2,972 (36.7)	34,058 (37.5)	0.67 (0.52–0.88)
West	24,879 (23.2)	1,678 (18.9)	23,201 (23.8)	0.52 (0.40–0.67)

↵* Other races include Hispanic, Asian, Native American, and multiple races.
↵† Other sources of payments include worker's compensation, other, and unknown.
↵‡ Not a reliable estimate due to a small number (<30) of patients with PCOS in the screening group.
↵§ High density lipoprotein (HDL) <35 mg/dL or triglycerides (TG) >250 mg/dL
BMI, body mass index; CI, confidence interval; CVD, cardiovascular disease; OR, odds ratio; PCOS, polycystic ovarian syndrome; CHF congestive heart failure; CAD, coronary artery disease.