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Screening for Prediabetes and Diabetes in a National Network of Federally Qualified Health Centers: An Observational Study

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Abstract

Background

In 2021, the U.S. Preventive Services Task Force (USPSTF) recommended screening for prediabetes and diabetes among adults aged 35–70 years with overweight or obesity. Studying dysglycemia screening in federally qualified health centers (FQHCs) that serve vulnerable patient populations is needed to understand health equity implications of this recommendation.

Objective

To investigate screening practices among FQHC patients who would be eligible according to the 2021 USPSTF recommendation.

Design

Retrospective cohort study analyzing electronic health records from a national network of 282 FQHC sites.

Participants

We included 183,329 patients without prior evidence of prediabetes or diabetes, who had ≥ 1 office visit from 2018–2020.

Main Measures

Screening eligibility was based on age and measured body mass index (BMI). The primary outcome, screening completion, was ascertained using hemoglobin A1c or fasting plasma glucose results from 2018–2020.

Key Results

Among 89,543 patients who would be eligible according to the 2021 USPSTF recommendation, 53,263 (59.5%) were screened. Those who completed screening had higher BMI values than patients who did not (33.0 ± 6.7 kg/m2 vs. 31.9 ± 6.2 kg/m2, p < 0.001). Adults aged 50–64 years had greater odds of screening completion relative to younger patients (OR 1.13, 95% CI: 1.10–1.17). Patients from racial and ethnic minority groups, as well as those without health insurance, were more likely to complete screening than White patients and insured patients, respectively. Clinical risk factors for diabetes were also associated with dysglycemia screening. Among patients who completed screening, 23,588 (44.3%) had values consistent with prediabetes or diabetes.

Conclusions

Over half of FQHC patients who would be eligible according to the 2021 USPSTF recommendation were screened. Screening completion was higher among middle-aged patients, those with greater BMI values, as well as vulnerable groups with a high risk of developing diabetes. Future research should examine adoption of the 2021 USPSTF screening recommendation and its impact on health equity.

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Data Availability

Those interested in accessing the study data should contact the corresponding author.

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Acknowledgements:

We gratefully acknowledge the FQHCs who contributed data to the current study, and their leadership for agreeing to make the data available for analysis.

Funding

This work was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (P30-DK092949).

Author information

Authors and Affiliations

  1. Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, Suite 680, Chicago, IL, 60611, USA

    Matthew J. O’Brien MD, MSc, Stacy C. Bailey PhD, MPH, Dyanna L. Gregory MSc & Ronald T. Ackermann MD, MPH

  2. Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Matthew J. O’Brien MD, MSc, Stacy C. Bailey PhD, MPH, Dyanna L. Gregory MSc, Andrew L. Owen PhD & Ronald T. Ackermann MD, MPH

  3. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Matthew J. O’Brien MD, MSc & Sadiya S. Khan MD, MSc

  4. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Sadiya S. Khan MD, MSc

  5. AllianceChicago, Chicago, IL, USA

    Amro Hassan MS & Nivedita Mohanty MD

  6. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Nivedita Mohanty MD

  7. Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Michael E. Bowen MD, MPH

  8. Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Michael E. Bowen MD, MPH

Authors
  1. Matthew J. O’Brien MD, MSc
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  9. Michael E. Bowen MD, MPH
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Corresponding author

Correspondence to Matthew J. O’Brien MD, MSc.

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Conflicts of Interest

Matthew J. O’Brien: No financial conflicts of interest to report.

Stacy C. Bailey: Dr. Bailey reports receiving research grants from the following organizations that were paid to Northwestern University: NIH, Gordon and Betty Moore Foundation, Pfizer, Eli Lilly, Lundbeck, Merck, Gilead, and the Retirement Research Foundation for Aging. Dr. Bailey reports receiving personal consulting fees from Lundbeck, Pfizer, Sanofi, Luto UK, and the University of Westminster. Dr. Bailey reports receiving personal fees for participation on a scientific advisory board at Gilead and support for travel from NIH and Gilead. None of these potential financial conflicts of interest are related to the current work.

Dyanna L. Gregory: No financial conflicts of interest to report.

Andrew L. Owen: No financial conflicts of interest to report.

Sadiya S. Khan: No financial conflicts of interest to report.

Ronald T. Ackermann: Dr. Ackermann reports receiving personal consulting fees from UnitedHealth Group unrelated to the current work.

Amro Hassan: No financial conflicts of interest to report.

Nivedita Mohanty: No financial conflicts of interest to report.

Michael Bowen: No financial conflicts of interest to report.

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O’Brien, M.J., Bailey, S.C., Gregory, D.L. et al. Screening for Prediabetes and Diabetes in a National Network of Federally Qualified Health Centers: An Observational Study. J GEN INTERN MED 38, 3541–3548 (2023). https://doi.org/10.1007/s11606-023-08402-1

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