preventing type 2 diabetes: a guide to refer patients to...
TRANSCRIPT
A g
uid
e to
refe
r you
r patie
nts w
ith p
red
iab
ete
s to
an
evid
en
ce-b
ase
d d
iab
ete
s pre
ven
tion
pro
gra
m
TYPE 2P
RE
VE
NT
ING
DIA
BE
TE
S
– 1
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Use this guide to help your patients delay or prevent the onset of type 2 diabetes
Pre
dia
be
tes is a
he
alth
con
ditio
n ch
ara
cterize
d b
y blo
od
glu
cose
leve
ls tha
t are
hig
he
r tha
n n
orm
al, b
ut n
ot h
igh
en
ou
gh
to b
e d
iag
no
sed
as d
iab
ete
s. Pre
dia
be
tes in
crea
ses th
e risk fo
r type
2 d
iab
ete
s, he
art d
isea
se a
nd
stroke
.
Pre
dia
be
tes is tre
ata
ble
, bu
t on
ly ab
ou
t 10
pe
rcen
t of p
eo
ple
wh
o h
ave it a
re aw
are
tha
t the
y do
. Left u
ntre
ate
d u
p to
on
e-th
ird o
f pe
op
le w
ith p
red
iab
ete
s will p
rog
ress to
dia
be
tes w
ithin
five
yea
rs.
Du
ring
tha
t win
do
w o
f time
you
r pa
tien
ts can
be
ne
fit fro
m a
pro
ven
lifestyle
cha
ng
e in
terve
ntio
n th
at is p
art o
f the
Na
tion
al D
iab
ete
s Pre
ven
tion
Pro
gra
m (N
atio
na
l DP
P) le
d b
y the
Ce
nte
rs for D
isea
se C
on
trol a
nd
Pre
ven
tion
(CD
C).
As p
art o
f the
Na
tion
al D
PP, th
e A
me
rican
Me
dica
l Asso
ciatio
n (A
MA
) an
d th
e C
DC
are
colla
bo
ratin
g to
crea
te to
ols a
nd
reso
urce
s tha
t care
tea
ms ca
n u
se to
ide
ntify p
atie
nts w
ith p
red
iab
ete
s, an
d re
fer e
ligib
le p
atie
nts to
in-p
erso
n o
r on
line
dia
be
tes p
reve
ntio
n p
rog
ram
s.
Ph
ysician
s an
d ca
re te
am
s from
a d
iverse
gro
up
of p
ractice
s he
lpe
d th
e A
MA
an
d th
e C
DC
crea
te th
e to
ols in
this g
uid
e,
an
d h
ave u
sed
the
m in
the
ir ow
n p
ractice
s to:
• S
cree
n a
nd
ide
ntify p
atie
nts fo
r pre
dia
be
tes
• R
efe
r pa
tien
ts to d
iab
ete
s pre
ven
tion
pro
gra
ms
• C
rea
te fe
ed
ba
ck loo
ps, lin
kin
g th
e p
atie
nt’s p
rog
ress in
the
dia
be
tes p
reve
ntio
n p
rog
ram
ba
ck to th
e p
ractice
Part of a national movem
ent
To ach
ieve
CD
C re
cog
nitio
n as p
art of th
e N
ation
al DP
P, pro
gram
s mu
st pro
vide
evid
en
ce th
ey are
follo
win
g a C
DC
-app
rove
d
curricu
lum
and
achie
ving
me
anin
gfu
l resu
lts with
patie
nts. T
he
se p
rog
rams are
base
d o
n re
search
sho
win
g th
at a year-lo
ng
,
structu
red
lifestyle
chan
ge
inte
rven
tion
red
uce
d th
e in
cide
nce
of d
iabe
tes b
y 58
pe
rcen
t amo
ng
adu
lts with
pre
diab
ete
s and
by 7
1 p
erce
nt in
tho
se ag
ed
60
years o
r old
er.
Th
ese
pro
gra
ms a
re su
ccessfu
l in p
art b
eca
use
the
y req
uire
on
ly mo
de
rate
we
igh
t loss to
ach
ieve
pre
ven
tive h
ea
lth
be
ne
fits. W
eig
ht lo
ss of 5
to 7
pe
rcen
t of b
od
y we
igh
t—1
0 to
14
po
un
ds fo
r a p
erso
n w
eig
hin
g 2
00
po
un
ds—
led
to th
e
resu
lts me
ntio
ne
d a
bo
ve.
Th
e A
MA
an
d th
e C
DC
are
pro
mo
ting
the
se d
iab
ete
s pre
ven
tion
pro
gra
ms b
eca
use
the
y are
on
e o
f the
mo
st eff
ective
ways
to h
elp
ph
ysician
s pre
ven
t or d
elay typ
e 2
dia
be
tes in
hig
h-risk p
atie
nts.
Use this im
plementation guide and its tools to help identify and refer patients w
ith prediabetes to a diabetes prevention program
that is part of the CDC’s N
ational DPP.
Pre
ve
ntin
g d
iab
ete
s: Ma
kin
g a
diff
ere
nce
by
link
ing
th
e clin
ic with
the
com
mu
nity.
In the average primary care practice, it’s likely that one-third of patients over age 18, and half over age 65,
have prediabetes.
– 2
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Ov
erv
iew
of g
uid
e to
ols
ResourcePurpose
Engage clinicians
You can prevent type 2 diabetes H
ealth care p
rovid
er fact sheet
Pro
vides a b
rief overview
of th
e eviden
ce-b
ased d
iabetes p
reventio
n p
rog
ram an
d a ratio
nale fo
r eng
agin
g
with
the p
rog
ram, su
ch as im
pro
ved p
atient o
utco
mes. A
lso assists clin
icians in
advo
cating
to th
eir colleag
ues
and
leaders ab
ou
t the valu
e of in
corp
oratin
g d
iabetes p
reventio
n screen
ing
and
referral into
their p
ractices.
Engage patients
Diabetes Risk A
ssessments
CD
C an
d A
merican
Diab
etes Asso
ciation
(AD
A) q
uestio
nn
aires
Off
ers an ed
ucatio
nal o
pp
ortu
nity fo
r patien
ts to learn
abo
ut th
eir risk for p
rediab
etes, and
help
ph
ysicians
and
care teams id
entify th
eir patien
ts at great risk.
Promoting prediabetes aw
areness to your patients 8
" x 11" po
ster)
Help
s practices in
crease patien
t awaren
ess of p
rediab
etes to
pave th
e way fo
r con
versation
s with
patien
ts
abo
ut screen
ing
and
referral.
Are you at risk for type 2 diabetes?
Patien
t han
do
ut
For u
se by p
hysician
practices in
patien
t waitin
g areas to
increase p
atient aw
areness an
d p
ave the w
ay for
con
versation
s with
patien
ts abo
ut screen
ing
and
referral.
So you have prediabetes …
now w
hat? P
atient h
and
ou
t
For u
se by p
hysician
practices in
the exam
roo
m after screen
ing
has revealed
that a p
atient h
as pred
iabetes.
Help
s the p
atient leave th
e offi
ce visit with
con
crete info
rmatio
n fo
r later reference.
Sample “Patient letter/em
ail and phone script”
Enab
les ph
ysician p
ractices to co
nd
uct effi
cient fo
llow
-up
and
referral with
patien
ts wh
o h
ave been
iden
tified
as havin
g p
rediab
etes, info
rmin
g th
em o
f their p
rediab
etes status an
d referral to
an evid
ence
-based
diab
etes
preven
tion
pro
gram
.
Incorporate screening, testing and referral into practice
M.A
.P. to diabetes prevention for your practice O
ne
-pag
e overview
Off
ers practices a o
ne
-pag
e road
map
to ap
plyin
g th
e elemen
ts of th
e diab
etes preven
tion
screenin
g an
d
referral gu
ide.
Patient flow process
Info
grap
hic
Pro
vides a h
igh
-level overview
of h
ow
offi
ce staff can
facilitate po
int-o
f-care iden
tificatio
n.
Point-of-care prediabetes identification algorithm
In
fog
raph
ic and
narrative
With
a grap
hic o
n o
ne sid
e, and
narrative o
n o
ther, th
e do
cum
ent o
ffers p
ractices an o
ptio
n to
adap
t/
inco
rpo
rate a pred
iabetes screen
ing
and
referral pro
cess into
their w
orkfl
ow
.
Retrospective prediabetes identification algorithm
In
fog
raph
ic and
narrative
With
a grap
hic o
n o
ne sid
e, and
narrative o
n o
ther, th
e do
cum
ent o
ffers p
ractices an o
ptio
n to
adap
t/
inco
rpo
rate an id
entifi
cation
and
referral pro
cess into
their electro
nic h
ealth reco
rds an
d g
enerate a reg
istry
of p
atients at risk fo
r type 2
diab
etes.
Sample patient referral form
/table for calculating body m
ass indexM
akes the referral p
rocess easier fo
r practices, h
elps en
gag
e the p
atient (p
articularly if th
ey sign
the o
ptio
nal
patien
t sign
ature b
ox) an
d p
repares d
iabetes p
reventio
n p
rog
ram p
rovid
ers to en
gag
e with
the p
atient as w
ell.
Comm
only used CPT and ICD codes
Table
Enab
les ph
ysician p
ractices to o
btain
reimb
ursem
ent fo
r pred
iabetes screen
ing
.
Connect your clinic with diabetes prevention program
s
Link to sample “Business
Associate A
greement” o
n
AM
A's w
ebsite
Pro
vides lin
k to tem
plate ag
reemen
t som
e practices h
ave used
to sh
are info
rmatio
n w
ith d
iabetes p
reventio
n
pro
gram
pro
viders.
– 3
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Additional inform
ation
AM
A diabetes prevention initiative
pre
ven
tdia
be
tessta
t.org
Lea
rn m
ore
ab
ou
t the
AM
A’s co
mm
itme
nt to
pre
ven
ting
type
2 d
iab
ete
s.
Centers for Disease Control and Prevention’s N
ational Diabetes Prevention Program
cd
c.go
v/d
iab
ete
s/pre
ven
tion
Visit th
is site fo
r de
taile
d in
form
atio
n a
bo
ut th
e C
DC
’s Na
tion
al D
iab
ete
s Pre
ven
tion
Pro
gra
m.
National D
iabetes Education Program
nd
ep
.nih
.go
v/a
m-i-a
t-risk/
Find
ed
uca
tion
al re
sou
rces a
bo
ut p
reve
ntin
g d
iab
ete
s for yo
u a
nd
you
r pa
tien
ts.
How
does a diabetes prevention program w
ork?
Dia
be
tes p
reve
ntio
n p
rog
ram
s tha
t are
pa
rt of th
e N
ation
al D
PP
use
lifestyle
cha
ng
e in
terve
ntio
ns th
at ta
rge
t imp
rov
ing
die
t, incre
asin
g p
hysica
l activ
ity an
d a
chie
vin
g m
od
era
te w
eig
ht lo
ss.
The
go
al for e
ach p
articipan
t is to lo
se ≥
5%
of b
od
y we
igh
t by:
• P
rog
ressive
ly red
ucin
g d
ieta
ry inta
ke o
f calo
ries a
nd
fat th
rou
gh
imp
rove
d fo
od
cho
ices
• G
rad
ua
lly incre
asin
g m
od
era
te p
hysica
l activ
ity (e.g
., brisk w
alk
ing
) to ≥
15
0 m
inu
tes p
er w
ee
k
• D
eve
lop
ing
be
hav
iora
l pro
ble
m-so
lvin
g a
nd
cop
ing
skills
Fea
ture
s inclu
de
:
• A
yea
r-lon
g stru
cture
d p
rog
ram
(in-p
erso
n g
rou
p, o
nlin
e o
r dista
nce
lea
rnin
g) co
nsistin
g o
f:
–
A
n in
itial six-m
on
th p
ha
se o
ffe
ring
at le
ast 1
6 se
ssion
s ove
r 16
–2
4 w
ee
ks
–
A
seco
nd
six-mo
nth
ph
ase
off
erin
g a
t lea
st on
e se
ssion
a m
on
th (a
t lea
st six sessio
ns)
• Fa
cilitatio
n b
y a tra
ine
d life
style co
ach
• U
se o
f a C
DC
-ap
pro
ved
curricu
lum
• R
eg
ula
r op
po
rtun
ities fo
r dire
ct inte
ractio
n b
etw
ee
n th
e life
style co
ach
an
d p
articip
an
ts
• A
n e
mp
ha
sis on
be
hav
ior m
od
ifica
tion
, ma
na
gin
g stre
ss an
d p
ee
r sup
po
rt
Who is eligible for referral to a diabetes prevention program
? To
be
elig
ible
for re
ferra
l, pa
tien
ts mu
st:
• B
e a
t lea
st 18
yea
rs old
and•
Be
ove
rwe
igh
t (Bo
dy M
ass In
de
x (BM
I) ≥2
4*; ≥
22
if Asia
n) and
• H
ave a
blo
od
test re
sult in
the
pre
dia
be
tes ra
ng
e w
ithin
the
pa
st yea
r:
–
H
em
og
lob
in A
1C
: 5.7
–6
.4%
or
–
Fastin
g p
lasm
a g
luco
se: 1
00
–1
25
mg
/dL or
–
Tw
o-h
ou
r pla
sma
glu
cose
(afte
r a 7
5 g
m g
luco
se lo
ad
): 14
0–
19
9 m
g/d
L or•
Be
pre
vio
usly d
iag
no
sed
with
ge
statio
na
l dia
be
tes a
nd
• H
ave n
o p
rev
iou
s dia
gn
osis o
f dia
be
tes
Ph
ysician
s an
d o
the
r he
alth
care
pro
vid
ers sh
ou
ld a
lso u
se th
eir in
de
pe
nd
en
t jud
gm
en
t wh
en
refe
rring
to a
dia
be
tes
pre
ven
tion
pro
gra
m.
* So
me
dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
ers re
qu
ire a
BM
I of ≥
25
. Ple
ase
che
ck with
you
r dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
er fo
r elig
ibility
req
uire
me
nts.
– 4
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
How
can patients find a diabetes prevention program near them
? D
iab
ete
s pre
ven
tion
pro
gra
ms a
re av
aila
ble
in v
arie
d lo
catio
ns su
ch a
s loca
l YM
CA
s, we
llne
ss cen
ters, fa
ith-b
ase
d
org
an
izatio
ns a
nd
wo
rksites—
as w
ell a
s in h
ea
lth ca
re fa
cilities. O
nlin
e ve
rsion
s are
also
ava
ilab
le. V
isit nccd
.cdc.g
ov
/DD
T_
DP
RP
/Re
gistry.a
spx to
fin
d a
pro
gra
m th
at is p
art o
f the
CD
C’s N
atio
na
l DP
P re
cog
nitio
n p
rog
ram
.
Does health insurance cover patient participation in a diabetes prevention program
?A
gro
win
g n
um
be
r of p
riva
te h
ea
lth in
sure
rs off
er co
vera
ge
for p
atie
nt p
articip
atio
n in
dia
be
tes p
reve
ntio
n p
rog
ram
s.
Se
vera
l em
plo
yers in
clud
e co
vera
ge
as p
art o
f wo
rkp
lace
we
llne
ss pro
gra
ms. C
osts fo
r a fu
ll yea
r of p
rog
ram
pa
rticipa
tion
are
ap
pro
xima
tely $
40
0–
$5
00
. So
me
pro
gra
m p
rov
ide
rs off
er m
on
thly p
ayme
nt p
lan
s an
d d
iscou
nts b
ase
d o
n a
bility to
pay.
Th
e A
MA
an
d th
e C
DC
con
tinu
e to
ad
voca
te fo
r pu
blic a
nd
priv
ate
insu
ran
ce co
vera
ge
of th
e d
iab
ete
s pre
ven
tion
pro
gra
m.
How
do I code for prediabetes screening?D
ep
en
din
g o
n th
e typ
e o
f offi
ce v
isit, pra
ctices ca
n u
se se
vera
l CP
T a
nd
ICD
cod
es to
bill fo
r pre
dia
be
tes scre
en
ing
an
d
cou
nse
ling
. A list o
f com
mo
nly u
sed
CP
T a
nd
ICD
cod
es is in
clud
ed
in th
is gu
ide
.
Feedback from diabetes prevention program
to referring clinicians
Mo
st pro
gra
ms se
nd
rep
orts o
f pa
rticipa
nt p
rog
ress to
refe
rring
clinicia
ns a
fter th
e e
igh
th a
nd
16
th g
rou
p se
ssion
s. In
ad
ditio
n, p
articip
an
ts in th
e p
rog
ram
com
ple
te p
erio
dic se
lf-ev
alu
atio
ns th
at re
ferrin
g clin
ician
s can
req
ue
st dire
ctly from
pa
tien
ts.
Sending patient information to a diabetes prevention program
providerBusiness A
ssociate Agreem
ent U
nd
er th
e U
.S. H
ea
lth In
sura
nce
Po
rtab
ility an
d A
ccou
nta
bility A
ct of 1
99
6 (H
IPAA
), a H
IPAA
Bu
sine
ss Asso
ciate
Ag
ree
me
nt
(BA
A) is a
con
tract th
at p
rote
cts pe
rson
al h
ea
lth in
form
atio
n in
acco
rda
nce
with
HIPA
A g
uid
elin
es. S
om
e p
hysicia
n p
ractice
s
may w
an
t to e
xplo
re w
he
the
r a B
AA
is ne
ed
ed
to e
xcha
ng
e in
form
atio
n w
ith a
dia
be
tes p
reve
ntio
n p
rog
ram
. (Link to
a
“Bu
sine
ss Asso
ciate
s Ag
ree
me
nt” te
mp
late
on
AM
A's w
eb
site.)
– 5
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Engage clinicians
– 6
–
Yo
u ca
n p
rev
en
t typ
e 2
dia
be
tes
Test your patients for prediabetes and refer those at risk to an evidence-based diabetes prevention program
Yo
u like
ly kn
ow
wh
ich o
f you
r patie
nts is at h
igh
risk for ty
pe
2 d
iab
ete
s. Un
til no
w yo
u m
ay no
t have
ha
d a
reso
urce
to
he
lp th
em
stop
the
pro
gre
ssion
from
pre
dia
be
tes to
dia
be
tes. N
ow
, you
do
.
Th
e A
me
rican
Me
dica
l Asso
ciation
an
d th
e C
en
ters fo
r Dise
ase C
on
trol a
nd
Pre
ven
tion
(CD
C) h
ave cre
ated
a to
olk
it that
can
he
lp p
hysicia
n p
ractice
s scree
n a
nd
refe
r patie
nts to
ev
ide
nce
-base
d d
iab
ete
s pre
ven
tion
pro
gra
ms w
itho
ut a
dd
ing
a b
urd
en
to yo
ur p
ractice
. Visit preventdiabetesstat.org
to le
arn
mo
re.
• P
rog
ressio
n fro
m p
red
iab
ete
s to d
iab
ete
s can
take
as little
as fi
ve ye
ars.
• D
urin
g th
at w
ind
ow
of tim
e, yo
ur p
atie
nts ca
n b
en
efi
t from
a p
rove
n in
terve
ntio
n th
at is p
art o
f the
CD
C’s
Na
tion
al D
iab
ete
s Pre
ven
tion
Pro
gra
m (N
atio
na
l DP
P).
• C
ou
nse
l you
r pa
tien
ts tha
t pre
dia
be
tes is a
po
ten
tially re
versib
le co
nd
ition
, an
d o
ne
tha
t you
can
he
lp th
em
ma
na
ge
eff
ective
ly by
:
–
S
cree
nin
g a
nd
Ide
ntifyin
g p
atie
nts fo
r pre
dia
be
tes
–
R
efe
rring
the
m to
a p
rog
ram
tha
t is pa
rt of th
e C
DC
’s Na
tion
al D
PP
This program is evidence-based
• T
he
dia
be
tes p
reve
ntio
n p
rog
ram
is a life
style in
terventio
n b
ased o
n research
fun
ded
by th
e Natio
nal In
stitute
s of H
ea
lth
tha
t sho
we
d, a
mo
ng
tho
se w
ith p
red
iab
ete
s, a 5
8 p
erce
nt re
du
ction
in th
e n
um
be
r of n
ew
case
s of d
iab
ete
s ove
rall,
an
d a
71
pe
rcen
t red
uctio
n in
ne
w ca
ses fo
r tho
se o
ver a
ge
60
.
• T
he
se re
sults w
ere
ach
ieve
d th
rou
gh
red
ucin
g ca
lorie
s, incre
asin
g p
hysica
l activ
ity, an
d a
we
igh
t loss o
f just 5
to 7
pe
rcen
t of b
od
y we
igh
t—1
0 to
14
po
un
ds fo
r a p
erso
n w
eig
hin
g 2
00
po
un
ds.*
• B
ase
d o
n stro
ng
ev
ide
nce
of e
ffe
ctiven
ess in
red
ucin
g n
ew
-on
set d
iab
ete
s, the
Co
mm
un
ity Pre
ven
tive S
erv
ices Ta
sk
Force
( the
com
mu
nityg
uid
e.o
rg) n
ow
reco
mm
en
ds co
mb
ine
d d
iet a
nd
ph
ysical a
ctivity p
rom
otio
n p
rog
ram
s like th
e
Na
tion
al D
PP, fo
r pe
op
le a
t incre
ase
d risk o
f type
2 d
iab
ete
s.
Program overview
• T
he
pro
gra
m e
mp
ow
ers p
atie
nts w
ith p
red
iab
ete
s to ta
ke ch
arg
e o
f the
ir he
alth
an
d w
ell-b
ein
g.
• P
articip
an
ts me
et in
gro
up
s with
a tra
ine
d life
style co
ach
for 1
6 w
ee
kly se
ssion
s an
d 6
–8
mo
nth
ly follo
w-u
p se
ssion
s.
• T
he
se a
re N
OT
exe
rcise cla
sses. A
t the
se se
ssion
s pa
tien
ts lea
rn w
ays to in
corp
ora
te h
ea
lthie
r ea
ting
an
d m
od
era
te
ph
ysical a
ctivity, a
s we
ll as p
rob
lem
-solv
ing
, stress-re
du
ction
an
d co
pin
g sk
ills into
the
ir da
ily lives.
Se
e n
ex
t pa
ge
to d
ete
rmin
e w
hich
of yo
ur p
atien
ts is elig
ible
for th
e d
iab
ete
s pre
ven
tion
pro
gra
m.
In the average primary care practice it’s likely one-third of patients over age 18, and half over age 65, have
prediabetes.
* Visit http://diabetes.niddk.nih.gov/dm
/pubs/preventionprogram to
learn
mo
re ab
ou
t this re
search
.
– 7
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Locating a program
• P
rog
ram
s are
off
ere
d in
va
ried
loca
tion
s such
as lo
cal Y
MC
As, co
mm
un
ity cen
ters, fa
ith-b
ase
d o
rga
niza
tion
s,
ho
spita
ls an
d w
orksite
s, an
d a
re a
lso av
aila
ble
on
line
.
• Fin
d a
pro
gra
m fo
r you
r pa
tien
ts at cdc.gov/diabetes/prevention
.
Eligibility for the diabetes prevention program
A. Inclusion criteria:
–
C
urre
nt a
ge
≥1
8 ye
ars and
–
M
ost re
cen
t BM
I ≥2
4* (≥
22
if Asia
n) and
–
A
po
sitive la
b te
st resu
lt with
in p
rev
iou
s 12
mo
nth
s:
• Hb
A1
C 5
.7–
6.4
% (LO
INC
cod
e 4
54
8-4
) or
•
FP
G 1
00
–1
25
mg
/dL (LO
INC
cod
e 1
55
8-6
) or
•
OG
TT
14
0–
19
9 m
g/d
L (LOIN
C co
de
62
85
6-0
) or
–
Histo
ry of g
esta
tion
al d
iab
ete
s (ICD
-9: V
12
.21
)
B. Exclusion criteria:
– C
urre
nt d
iag
no
sis of d
iab
ete
s (ICD
-9: 2
50
.xx) or
–
Cu
rren
t Insu
lin u
se
Co
nsid
er re
ferrin
g e
ligib
le p
atien
ts:
• A
t the
time
of a
n o
ffice
visit, a
nd
/or
• B
y ge
ne
ratin
g a
list of e
ligib
le p
atie
nts fro
m yo
ur e
lectro
nic h
ea
lth re
cord
usin
g a
structu
red
qu
ery
Ph
ysician
s an
d o
the
r he
alth
care
pro
vid
ers sh
ou
ld a
lso u
se th
eir in
de
pe
nd
en
t jud
gm
en
t wh
en
refe
rring
to a
dia
be
tes
pre
ven
tion
pro
gra
m.
* So
me
dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
ers re
qu
ire a
BM
I of ≥
25
. Ple
ase
che
ck with
you
r dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
er fo
r
elig
ibility re
qu
irem
en
ts.
– 8
–
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Engage patients
– 9
–
Typ
e 2
dia
bete
s is mo
re co
mm
on
in A
frican
Am
erica
ns, H
ispan
ics/
Latin
os, A
merica
n In
dia
ns, a
nd
Asia
n A
merica
ns a
nd
Pacifi
c Islan
ders.
For m
ore in
form
ation
, visit us at
ww
w.d
iabetes.o
rg o
r call 1-800-DIA
BETES
AR
E YO
U A
T RISK
FOR
TYPE 2 D
IABETES?
If yo
u sco
red
5 o
r hig
her:
Yo
u a
re a
t incre
ase
d risk
for h
avin
g ty
pe 2
dia
bete
s.
Ho
wever, o
nly
yo
ur d
octo
r can
tell fo
r sure
if yo
u
do
have ty
pe 2
dia
bete
s or p
red
iab
ete
s (a co
nd
i-
tion
that p
rece
des ty
pe 2
dia
bete
s in w
hich
blo
od
glu
cose
levels a
re h
igh
er th
an
no
rmal). Ta
lk to
yo
ur d
octo
r to se
e if a
dd
ition
al te
sting
is need
ed
.
Ad
d u
p
you
r score.
Heig
ht
Weig
ht (lb
s.)4
’ 10
”1
19
-14
21
43
-19
01
91
+
4’ 1
1”
12
4-1
47
14
8-1
97
19
8+
5’ 0
”1
28
-15
21
53
-20
32
04
+
5’ 1
”1
32
-15
71
58
-21
02
11
+
5’ 2
”1
36
-16
31
64
-21
72
18
+
5’ 3
”1
41
-16
81
69
-22
42
25
+
5’ 4
”1
45
-17
31
74
-23
12
32
+
5’ 5
”1
50
-17
91
80
-23
92
40
+
5’ 6
”1
55
-18
51
86
-24
62
47
+
5’ 7
”1
59
-19
01
91
-25
42
55
+
5’ 8
”1
64
-19
61
97
-26
12
62
+
5’ 9
”1
69
-20
22
03
-26
92
70
+
5’ 1
0”
17
4-2
08
20
9-2
77
27
8+
5’ 1
1”
17
9-2
14
21
5-2
85
28
6+
6’ 0
”1
84
-22
02
21
-29
32
94
+
6’ 1
”1
89
-22
62
27
-30
13
02
+
6’ 2
”1
94
-23
22
33
-31
03
11
+
6’ 3
”2
00
-23
92
40
-31
83
19
+
6’ 4
”2
05
-24
52
46
-32
73
28
+
(1 P
oin
t)(2
Po
ints)
(3 P
oin
ts)
Yo
u w
eig
h le
ss tha
n th
e a
mo
un
t
in th
e le
ft colu
mn
(0 p
oin
ts)
Dia
bete
s Risk
Test
123
Write yo
ur sco
re in
the b
ox.
4567
Ho
w o
ld are yo
u?
40—
49 y
ears (1
po
int)
50—
59 y
ears (2
po
ints)
60 y
ears o
r old
er (3
po
ints)
Are yo
u a m
an o
r a wo
man
?
Man
(1 p
oin
t) Wo
man
(0 p
oin
ts)
If you
are a wo
man
, have yo
u ever b
een
diag
no
sed w
ith g
estation
al diab
etes?
Yes (1
po
int) N
o (0
po
ints)
Do
you
have a m
oth
er, father, sister, o
r b
roth
er with
diab
etes?
Yes (1
po
int) N
o (0
po
ints)
Have yo
u ever b
een d
iagn
osed
with
hig
h
blo
od
pressu
re?
Yes (1
po
int) N
o (0
po
ints)
Are yo
u p
hysically active?
Yes (0
po
ints) N
o (1
po
int)
Wh
at is you
r weig
ht statu
s? (see ch
art at righ
t)
Ad
ap
ted
from
Ban
g e
t al., A
nn
Inte
rn M
ed
151:7
75-7
83, 2
009.
Orig
inal a
lgo
rithm
was v
alid
ate
d w
itho
ut
gesta
tion
al d
iab
ete
s as p
art o
f the m
od
el.
Low
er You
r Risk
Th
e g
oo
d n
ew
s is that y
ou
can
man
ag
e y
ou
r risk
for ty
pe 2
dia
bete
s. Sm
all ste
ps m
ake a
b
ig d
iffere
nce
an
d ca
n h
elp
yo
u liv
e a
lon
ger,
health
ier life
.If y
ou
are
at h
igh
risk, y
ou
r first ste
p is to
se
e y
ou
r do
ctor to
see if a
dd
ition
al te
sting
is n
eed
ed
.
Visit d
iab
ete
s.org
or ca
ll 1-8
00-D
IAB
ETES fo
r in
form
atio
n, tip
s on
gettin
g sta
rted
, an
d
ideas fo
r simp
le, sm
all ste
ps y
ou
can
take to
h
elp
low
er y
ou
r risk.
Visit u
s on
Face
bo
ok
Face
bo
ok.co
m/A
merica
nD
iab
ete
sAsso
ciatio
n
Pa
tien
t risk a
ssessm
en
t
Co
pyrig
ht A
me
rican D
iabe
tes A
ssociatio
n. U
sed
with
pe
rmissio
n.
– 1
0 –
CD
C Predia
betes
Screenin
g Test
CO
ULD
YO
U H
AVE P
RED
IAB
ETE
S?
Pre
dia
bete
s m
eans yo
ur b
lood g
lucose (s
ugar) is
hig
her th
an n
orm
al, b
ut n
ot ye
t dia
bete
s.
cose (s
ugar) is
hig
her th
an
Dia
bete
s is
a s
erio
us d
isease th
at c
an c
ause h
eart a
ttack, s
troke, b
lindness, k
idney
at c
an c
ause h
eart a
ttack, s
tr
failu
re, o
r loss o
f feet o
r legs. T
y 2
dia
bete
s c
an b
e d
el
ed o
r pre
vente
d in
people
with
Typ
e 2
dia
bete
s c
an b
e d
ela
yed o
pre
dia
bete
s th
rough e
ffective
lifestyle
ra
ms. T
ake th
e fi
rst s
tep. F
ind o
ut yo
ur ris
k
lifestyle
pro
gra
ms. T
ake th
e fi
rst s
tep
for p
redia
bete
s.TA
KE TH
E TE
ST—
KN
OW
YO
UR
SC
OR
E!
sAnsw
er th
ese s
eve
n s
imple
questio
ns. F
or e
ach “Y
es” a
nsw
er, a
dd th
e n
um
ber o
f poin
tsseve
n s
imple
questio
ns. F
or e
ach “Y
es” a
nsw
er, a
dd th
e n
um
ber o
f
liste
d. A
ll “No” a
nsw
ers
are
0 p
oin
ts.
an
Are
you a
wom
an
an w
ho h
as h
ad a
baby w
eig
hin
g m
ore
than 9
pounds a
t bir
th?
ter
Do yo
u h
ave
a s
iste
rte
r or b
roth
er w
ith d
iabete
s?
with
Do yo
u h
ave
a p
are
nt w
ithw
ith d
iabete
s?
Do y
Fin
d yo
ur h
eig
ht o
n th
e c
hart. D
o y
Do yo
u w
eig
h a
s m
uch a
s o
r more
than th
e w
eig
ht lis
ted fo
r
your h
eig
ht?
no e
xerc
ise in
a typ
icAre
you yo
unger th
an 6
5 ye
ars
of a
ge a
nd g
et little
or n
o e
xerc
ise in
a
ypic
no e
xerc
ise in
a typ
ical d
ay?
Are
you b
etw
een 4
5 a
nd 6
4 ye
ars
of a
ge?
Are
you 6
5 ye
ars
of a
ge o
r old
er?
Add your score and check the back of this page to see w
hat it means.
Yes
1115559
No0000000
H
eig
ht
Weig
ht
Pounds
4’1
0”
12
9
4’1
1”
13
3
5’0
”1
38
5’1
”1
43
5’2
”1
47
5’3
”1
52
5’4
”1
57
5’5
”1
62
5’6
”1
67
Heig
ht
Weig
ht
Pounds
5
’7”
17
2
5’8
”1
77
5’9
”1
82
5’1
0”
18
8
5’1
1”
19
3
6’0
”1
99
6’1
”2
04
6’2
”2
10
6’3
”2
16
6’4
”2
21
AT-R
ISK
WEIG
HT C
HA
RT
Screenin
g test
– 1
1 –
CS232302A
IF YO
UR
SC
OR
E IS
3 TO
8 P
OIN
TSThis
means yo
ur ris
k is
pro
bably lo
w fo
r havin
g p
redia
bete
s n
ow. K
eep yo
ur ris
k lo
w. If yo
u’re
ove
rweig
ht,
edia
bete
s n
ow. K
eep yo
ur ris
k lo
w. I
lose w
eig
ht. B
e a
ctive
most d
ays
, and d
on’t u
se to
bacco. E
at lo
w-fa
t meals
with
fruits
, vegeta
ble
s, a
nd
tobacco. E
at lo
w-fa
t meals
with
whole
-gra
in fo
ods. If yo
u h
ave
hig
h c
hole
ste
rol o
r hig
h b
lood p
ressure
, talk
to yo
ur h
ealth
care
pro
vider
ol o
r hig
h b
lood p
ressure
, talk
to
about yo
ur ris
k fo
r type 2
dia
bete
s.
IF YO
UR
SC
OR
E IS
9 O
R M
OR
E P
OIN
TSThis
means yo
ur ris
k is
hig
h fo
r havin
g p
redia
bete
s n
ow. P
lease m
ake a
n a
ppoin
tment w
ith yo
ur h
ealth
care
g p
redia
bete
s n
ow. P
lease m
ake a
n a
pro
vider s
oon.
HO
W C
AN
I GET TE
STE
D FO
R P
RED
IAB
ETE
S?
Individual or group h
ealth in
surance:
a p
rovid
er, a
sk yo
ur
See yo
ur h
ealth
care
pro
vider. If yo
u d
on’t h
ave
a p
r
insura
nce c
om
pany a
bout p
rovid
ers
who ta
ke yo
ur in
sura
nce. D
eductib
les a
nd c
opays
may a
pply.
ers
who ta
ke yo
ur in
sura
nce. D
eductib
les a
nd c
opays
may a
pply.
Medicaid:
p S
ee yo
ur h
ealth
care
pro
vider. If yo
u d
on’t h
ave
a p
rovid
er, c
onta
ct a
sta
te M
edic
aid
offi
ce o
rpro
vider. If yo
u d
on’t h
ave
a p
rovid
er, c
onta
ct a
sta
te M
edic
aid
offi
ce o
r
me
conta
ct yo
ur lo
cal h
ealth
departm
em
ent.
Medicare:
ro S
ee yo
ur h
ealth
care
proro
vider. M
edic
are
will p
ay th
e c
ost o
f testin
g if th
e p
rovid
er h
as a
reason
er
for te
stin
g. If yo
u d
on’t h
ave
a p
rovid
er
er, c
onta
ct yo
ur lo
cal h
ealth
departm
ent.
No in
surance:
th d
Conta
ct yo
ur lo
cal h
ealth
dth
departm
ent fo
r more
info
rmatio
n a
bout w
here
you c
ould
be te
ste
d
or c
all yo
ur lo
cal h
ealth
clin
ic.
ww
w.cdc.gov/
diabetes
Havin
g p
red
iabe
tes m
ean
s you
are at in
crease
d risk fo
r de
velo
pin
g se
riou
s he
alth
pro
ble
ms su
ch as typ
e 2
diab
ete
s, stroke
and
he
art dise
ase.
You
cou
ld h
ave p
red
iabe
tes if yo
u h
ave:
� H
igh
cho
leste
rol o
r
� H
igh
blo
od
pre
ssure
or
� A
pare
nt, b
roth
er o
r sister w
ith d
iabe
tes
You
r risk go
es u
p if yo
u are
also o
verw
eig
ht, an
d/o
r ove
r age
45
.
If you
have
pre
diab
ete
s, we
can h
elp
!
Ask your doctor how
you can stop diabetes before it starts.
have p
rediab
etesYou could be one of them
.
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
– 1
2 –
– 1
3 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
1 in 3 U.S. adults has prediabetes.
Most don’t know
it. Are you at risk?
Yo
u m
ay have
pre
dia
be
tes a
nd
be
at risk for
typ
e 2
dia
be
tes if yo
u:
• A
re 4
5 ye
ars o
f ag
e o
r old
er
• A
re o
verw
eig
ht
• H
ave a
fam
ily histo
ry of typ
e 2
dia
be
tes
• H
ave h
igh
blo
od
pre
ssure
• A
re p
hysica
lly active
few
er th
an
thre
e tim
es
pe
r we
ek
• E
ver h
ad
dia
be
tes w
hile
pre
gn
an
t (ge
statio
na
l
dia
be
tes) o
r gave
birth
to a
ba
by th
at w
eig
he
d m
ore
tha
n 9
po
un
ds
Prediabetes can lead to serious health problem
s
Havin
g p
red
iabe
tes m
ean
s you
r blo
od
glu
cose
(sug
ar)
leve
l is hig
he
r tha
n n
orm
al, b
ut n
ot h
igh
en
ou
gh
to b
e
dia
gn
ose
d as d
iab
ete
s. Bu
t, ne
arly 9
0 p
erce
nt o
f adu
lts
wh
o h
ave p
red
iabe
tes d
on
’t kno
w th
ey h
ave it.
If you
have
pre
dia
be
tes a
nd
do
n’t lo
se w
eig
ht o
r incre
ase
you
r ph
ysical a
ctivity, yo
u co
uld
de
velo
p ty
pe
2 d
iab
ete
s
with
in fi
ve ye
ars. Ty
pe
2 d
iab
ete
s is a se
riou
s con
ditio
n
that ca
n le
ad
to h
ea
lth issu
es su
ch as h
ea
rt attack
, stroke
,
blin
dn
ess, k
idn
ey fa
ilure
, or lo
ss of to
es, fe
et o
r leg
s.
What can you do?
• Ta
lk to yo
ur d
octo
r ab
ou
t you
r risk of h
avin
g
pre
dia
be
tes.
Here’s the good new
s
If you
have
pre
dia
be
tes, yo
ur d
octo
r may re
fer yo
u to
a p
rove
n life
style ch
an
ge
pro
gra
m th
at can
he
lp yo
u
pre
ven
t or d
elay g
ettin
g ty
pe
2 d
iab
ete
s.
The National D
iabetes Prevention Program can
help!
Th
e N
ation
al D
iab
ete
s Pre
ven
tion
Pro
gra
m (N
ation
al D
PP
)
use
s a p
rog
ram
that is p
rove
n to
pre
ven
t or d
elay ty
pe
2
dia
be
tes, a
nd
will h
elp
you
low
er yo
ur risk b
y imp
rov
ing
you
r foo
d ch
oice
s an
d in
creasin
g p
hysica
l activ
ity.
Ho
w d
oe
s it wo
rk? As p
art o
f a g
rou
p in
you
r com
mu
nity
or o
nlin
e, yo
u w
ill wo
rk with
a tra
ine
d life
style co
ach
to
lea
rn th
e sk
ills you
ne
ed
to m
ake
lasting
lifestyle
cha
ng
es.
Yo
u w
ill lea
rn to
eat h
ea
lthy, a
dd
ph
ysical a
ctivity to
you
r
life, m
an
ag
e stre
ss, stay mo
tivate
d a
nd
solve
pro
ble
ms
that ca
n g
et in
the
way o
f he
alth
y cha
ng
es.
What participants are saying …
“ I love having a lifestyle coach. She has given us great inform
ation, helped me stay on track and stay positive!”
—
Bru
ce
“ I’m so excited because I w
ent to the doctor last week and all
of my num
bers were dow
n and I officially no longer have
prediabetes.” —
Viv
ien
Now
is the time to take charge of your health and
make a change! A
sk your doctor or nurse.
Are
yo
u a
t risk
for p
red
iab
ete
s?
Features•
Train
ed
coa
ch to
gu
ide
an
d e
nco
ura
ge
you
• In
-pe
rson
or o
nlin
e
• C
DC
-ap
pro
ved
pro
gra
m
• S
up
po
rt from
oth
ers w
ork
ing
on
the
sam
e g
oa
ls
as yo
u
• S
kills to
he
lp yo
u lo
se w
eig
ht, b
e m
ore
ph
ysically
active
an
d m
an
ag
e stre
ss
• S
om
e in
sura
nce
com
pa
nie
s will co
ver
– 1
4 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Pre
dia
be
tes m
ea
ns yo
ur b
loo
d g
luco
se (su
ga
r) leve
l
is hig
he
r tha
n n
orm
al, b
ut n
ot h
igh
en
ou
gh
to b
e
dia
gn
ose
d as d
iab
ete
s. Th
is con
ditio
n ra
ises yo
ur risk o
f
typ
e 2
dia
be
tes, stro
ke a
nd
he
art d
isease
.
What can you do about it?
Th
e g
oo
d n
ew
s is that th
ere
’s a p
rog
ram
that ca
n
he
lp yo
u.
Th
e N
ation
al D
iab
ete
s Pre
ven
tion
Pro
gra
m, le
d b
y the
Ce
nte
rs for D
isease
Co
ntro
l an
d P
reve
ntio
n (C
DC
), use
s a
me
tho
d p
rove
n to
pre
ven
t or d
elay ty
pe
2 d
iab
ete
s.
By im
pro
vin
g fo
od
cho
ices a
nd
incre
asing
ph
ysical
activ
ity, you
r go
al w
ill be
to lo
se 5
to 7
pe
rcen
t of yo
ur
bo
dy w
eig
ht—
that is 10
to 14
po
un
ds fo
r a p
erso
n
we
igh
ing
20
0 p
ou
nd
s.
Th
ese
lifestyle
cha
ng
es ca
n cu
t you
r risk of d
eve
lop
ing
typ
e 2
dia
be
tes b
y mo
re th
an
ha
lf.
How
does the program w
ork?
As p
art of a g
rou
p, yo
u w
ill wo
rk with
a traine
d d
iabe
tes
pre
ven
tion
coa
ch a
nd
oth
er p
articip
an
ts to le
arn
the
skills
you
ne
ed
to m
ake
lasting
lifestyle
cha
ng
es. Y
ou
will le
arn
to e
at he
alth
y, ad
d p
hysica
l activ
ity to yo
ur life
, ma
na
ge
stress, stay m
otiv
ated
an
d so
lve p
rob
lem
s that ca
n g
et in
the
way o
f he
alth
y cha
ng
es.
Th
e p
rog
ram
lasts on
e ye
ar, w
ith 16
sessio
ns ta
kin
g
pla
ce a
bo
ut o
nce
a w
ee
k an
d six to
eig
ht m
ore
sessio
ns
me
etin
g o
nce
a m
on
th. B
y go
ing
thro
ug
h th
e p
rog
ram
with
oth
ers w
ho
have
pre
dia
be
tes yo
u ca
n ce
leb
rate
ea
ch o
the
r’s succe
sses a
nd
wo
rk tog
eth
er to
ove
rcom
e
cha
llen
ge
s.
So
me
insu
ran
ce p
lan
s will co
ver th
e co
st of th
e p
rog
ram.
Ch
eck w
ith yo
ur in
suran
ce p
rovid
er to
see
if it is cove
red
.
Also
, som
e p
laces th
at pro
vide
the
pro
gram
will a
dju
st the
fee
you
pay b
ased
on
you
r inco
me
.
Why should you act now
?
With
ou
t we
igh
t loss a
nd
mo
de
rate p
hysica
l activ
ity, ma
ny
pe
op
le w
ith p
red
iabe
tes w
ill deve
lop
type
2 d
iabe
tes w
ithin
five
years. Typ
e 2
diab
ete
s is a serio
us co
nd
ition
that can
lead
to h
ealth
issue
s such
as he
art attack, stro
ke, b
lind
ne
ss,
kidn
ey failu
re, o
r loss o
f toe
s, fee
t or le
gs. N
OW
is the time
to take charge of your health and make a change.
What participants are saying …
“ I love having a lifestyle coach. She has given us great inform
ation, helped me stay on track and stay positive!”
—B
ruce
“ I’m so excited because I w
ent to the doctor last week and all
of my num
bers were dow
n and I officially no longer have
prediabetes.” —
Viv
ien
Sign up today for a program near you!
To fi
nd
a p
rog
ram
in o
ur a
rea
that is p
art o
f the
Natio
na
l
Dia
be
tes P
reve
ntio
n P
rog
ram
, visit cdc.gov/diabetes/
prevention.
Features of the program:
• A
train
ed
coa
ch to
gu
ide
an
d e
nco
ura
ge
you
• A
CD
C-a
pp
rove
d p
rog
ram
• G
rou
p su
pp
ort
• S
kills to
he
lp yo
u lo
se w
eig
ht, b
e m
ore
ph
ysically
active
an
d m
an
ag
e stre
ss
So
yo
u h
av
e
pre
dia
be
tes …
n
ow
wh
at?
– 1
5 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Le
tter te
mp
late
Use
/adap
t the
se te
mp
lates to
con
du
ct effi
cien
t follo
w-u
p an
d re
ferral w
ith p
atien
ts wh
o h
ave b
ee
n id
en
tifie
d as h
aving
pre
diab
ete
s
<<
YO
UR
LE
TT
ER
HE
AD
>>
<<
AD
DR
ES
S>
>
<<
PH
ON
E N
UM
BE
R>
>
<<
DA
TE
>>
<<
PA
TIE
NT
NA
ME
>>
<<
PA
TIE
NT
AD
DR
ES
S>
>
Dr. M
r./Mrs. <
<PA
TIEN
T L
AS
T N
AM
E>>
,
Th
ank yo
u fo
r be
ing
a patie
nt o
f the
<<
PR
AC
TIC
E N
AM
E H
ERE>
>. W
e are
writin
g to
tell yo
u ab
ou
t a service
to h
elp
make
you
r
he
alth b
ette
r.
Base
d o
n o
ur re
vie
w o
f you
r me
dica
l cha
rt, you
have
a co
nd
ition
kn
ow
n as p
red
iab
ete
s. Th
is me
an
s you
r blo
od
sug
ar is
hig
he
r tha
n n
orm
al, w
hich
incre
ases yo
ur risk o
f de
velo
pin
g se
riou
s he
alth
pro
ble
ms in
clud
ing
typ
e 2
dia
be
tes, as w
ell as
he
art d
isease
an
d stro
ke.
We
have
som
e g
oo
d n
ew
s. Ou
r offi
ce w
ants yo
u to
kno
w th
at you
may b
e e
ligib
le fo
r a diab
ete
s pre
ven
tion
pro
gram
run
by
ou
r partn
ers, <
<N
AM
E O
F P
RO
GR
AM
PR
OV
IDER
>>
. Th
is pro
gram
is pro
ven
to re
du
ce yo
ur risk o
f de
velo
pin
g d
iabe
tes an
d o
the
r
he
alth p
rob
lem
s.
We
have
sen
t a refe
rral to <
<N
AM
E O
F P
RO
GR
AM
PR
OV
IDER
>>
and
som
eo
ne
will call yo
u to
discu
ss the
pro
gram
, answ
er an
y
qu
estio
ns yo
u m
ay have
and
, if you
are in
tere
sted
, en
roll yo
u in
the
pro
gram
.
Ple
ase fe
el fre
e to
give
<<
NA
ME
OF
PR
OG
RA
M P
RO
VID
ER>
> a call at <
<P
HO
NE
NU
MB
ER>
>.
–OR–
We
have
sen
t a refe
rral to <
<N
AM
E O
F P
RO
GR
AM
PR
OV
IDER
>>
and
we
urg
e yo
u to
call <<
PH
ON
E N
UM
BER
>>
to le
arn m
ore
abo
ut th
e p
rog
ram an
d e
nro
ll.
We
ho
pe
you
will take
advan
tage
of th
is pro
gram
, wh
ich can
he
lp p
reve
nt yo
u fro
m d
eve
lop
ing
serio
us h
ealth
pro
ble
ms.
Since
rely,
Dr. <
<P
HY
SICIA
N L
AS
T N
AM
E>>
– 1
6 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Sa
mp
le “Ta
lkin
g p
oin
ts” for p
ho
ne
ou
trea
ch
• H
ello
<<
PAT
IEN
T N
AM
E>
>.
• I a
m ca
lling
from
<<
PR
AC
TIC
E N
AM
E H
ER
E>
>.
• I’m ca
lling
to te
ll you
ab
ou
t a p
rog
ram
we’d
like yo
u to
con
side
r, to h
elp
you
pre
ven
t som
e se
riou
s he
alth
pro
ble
ms.
• B
ase
d o
n o
ur re
vie
w o
f you
r me
dica
l cha
rt, you
have
a co
nd
ition
kn
ow
n a
s pre
dia
be
tes. T
his m
ea
ns yo
ur b
loo
d su
ga
r is
hig
he
r tha
n n
orm
al, w
hich
ma
kes yo
u m
ore
likely to
de
velo
p se
riou
s he
alth
pro
ble
ms in
clud
ing
type
2 d
iab
ete
s, stroke
an
d h
ea
rt dise
ase
.
• W
e h
ave so
me
go
od
ne
ws, to
o.
• Yo
u m
ay be
elig
ible
for a
dia
be
tes p
reve
ntio
n p
rog
ram
run
by o
ur p
artn
ers, <
<N
AM
E O
F P
RO
GR
AM
PR
OV
IDE
R>
>.
–
T
he
ir pro
gra
m is b
ase
d o
n re
sea
rch p
rove
n to
red
uce
you
r risk of d
eve
lop
ing
dia
be
tes a
nd
oth
er h
ea
lth p
rob
lem
s.
Option A
• W
e h
ave se
nt a
refe
rral to
<<
NA
ME
OF
PR
OG
RA
M P
RO
VID
ER
>>
an
d so
me
on
e w
ill call yo
u to
discu
ss the
pro
gra
m, a
nsw
er
an
y qu
estio
ns yo
u m
ay have
an
d, if yo
u a
re in
tere
sted
, en
roll yo
u in
the
pro
gra
m.
• P
lea
se fe
el fre
e to
give
<<
NA
ME
OF
PR
OG
RA
M P
RO
VID
ER
>>
a ca
ll at <
<P
HO
NE
NU
MB
ER
>>
.
• D
o yo
u h
ave a
ny q
ue
stion
s for m
e?
• T
ha
nk yo
u fo
r you
r time
an
d b
e w
ell.
Option B
• W
e h
ave se
nt a
refe
rral to
<<
NA
ME
OF
PR
OG
RA
M P
RO
VID
ER
>>
an
d w
e u
rge
you
to ca
ll <<
PH
ON
E N
UM
BE
R>
> to
lea
rn
mo
re a
bo
ut th
e p
rog
ram
an
d e
nro
ll.
• W
e h
op
e yo
u w
ill take
ad
va
nta
ge
of th
is pro
gra
m, w
hich
can
he
lp p
reve
nt yo
u fro
m d
eve
lop
ing
serio
us h
ea
lth p
rob
lem
s.
• D
o yo
u h
ave a
ny q
ue
stion
s for m
e?
• T
ha
nk yo
u fo
r you
r time
an
d b
e w
ell.
– 1
7 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Incorporate screening, testing and referral into
practice
– 18 –
M.A.P. (Measure, Act, Partner) THE M.A.P. (Measure, Act, Partner) to prevent type 2 diabetes—physicians and care teams can use this document to determine roles and responsibilities for identifying adult
patients with prediabetes and referring to community-based diabetes prevention programs. “Point-of-Care” and “Retrospective” methods may be used together or alone.
Choose and check what works best for your practice
Step 1: MeasureWhenWhoHow (draw from AMA-CDC tools)
Point-of-care method• Assess risk for prediabetes during routine office visit • Test and evaluate blood glucose level based on risk status
• At the front desk• During vital signs
• Receptionist • Medical assistant• Nurse• Physician• Other _______
• Provide “Are you at risk for prediabetes?” patient education handout in waiting area
• Use/adapt “Patient flow process” tool • Use CDC or ADA risk assessment questionnaire at check-in • Display 8 x 11” patient-facing poster promoting prediabetes
awareness to your patients• Use/adapt “Point-of-care algorithm”
Retrospective method
• Query EHR to identify patients with BMI ≥24* and blood glucose level in the
prediabetes range
• Every 6–12 months• Health IT staff
• Other _______
• Use/adapt “Retrospective algorithm”
Step 2: ActPoint-of-care method• Counsel patient re: prediabetes and treatment options during office visit• Refer patient to diabetes prevention program• Share patient contact info with program provider**
• During the visit• Medical assistant• Nurse• Physician• Other________
• Advise patient using “So you have prediabetes … now what?” handout
• Use/adapt “Health care practitioner referral form” • Refer to “Commonly used CPT and ICD codes”
Retrospective method• Inform patient of prediabetes status via mail, email or phone call• Make patient aware of referral and info sharing with program provider• Refer patient to diabetes prevention program• Share patient contact info with program provider**
• Contact patient soon after EHR query
• Health IT staff• Medical assistant
(for phone calls)• Other________
• Use/adapt “Patient letter/phone call” template • Use/adapt “Health care practitioner referral form” for making
individual referrals • Use/adapt “Business Associate Agreement” template on AMA's
website if needed
Step 3: PartnerWith diabetes prevention programs• Engage and communicate with your local diabetes prevention program • Establish process to receive feedback from program about your patients’
participation
• Establish contact before making 1st referral
• Office manager• Other________
Use/adapt “Business Associate Agreement” template on AMA's website if needed Refer to “Commonly used CPT and ICD codes”
With patients• Explore motivating factors important to the patient • At follow-up visit, order/review blood tests to determine impact of program
and reinforce continued program participation• Discuss program feedback with patient and integrate into care plan
• During office visit• Other________
• Medical assistant• Nurse• Physician• Other________
• Advise patient using “So you have prediabetes … now what?” handout and provide CDC physical activity fact sheet www.cdc.gov/physicalactivity
* Some diabetes prevention program providers require a BMI of ≥25. Please check with your diabetes prevention program provider for eligibility requirements.
Following the M.A.P. for Preventing Type 2 Diabetes can help your practice achieve Patient Centered Medical Home (PCMH) recognition, as well as Meaningful Use of your electronic medical record. (Supports PCMH recognition via Standard 4: Self-Care Support, B. Provide Referrals to Community Resources (3 points), NCQA Facilitating PCMH Recognition, 2011.)** To share patient contact information with a diabetes prevention program, you may need a Business Associate Agreement (BAA).
The American Medical Association and the Centers for Disease Control and Prevention have created a tool kit that can help physician practices screen and refer patients to evidence-based diabetes prevention programs. Visit preventdiabetesstat.org to learn more. Physicians and other health care providers should also use their independent judgment when referring to a diabetes prevention program.
– 1
9 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Sa
mp
le p
atie
nt fl
ow
pro
cess
FOLLO
W U
P •
Co
nta
ct pa
tien
t an
d tro
ub
lesh
oo
t issue
s with
en
rollm
en
t
or p
articip
atio
n
REFERRA
L •
Co
mp
lete
an
d su
bm
it refe
rral fo
rm v
ia fa
x or e
ma
il
EXA
M/CO
NSU
LT•
Follo
w “P
oin
t-of-ca
re p
red
iab
ete
s ide
ntifi
catio
n a
lgo
rithm
”
• D
ete
rmin
e if p
atie
nt h
as p
red
iab
ete
s an
d B
MI ≥
24
*
(≥ 2
2 fo
r Asia
ns) o
r a h
istory o
f GD
M
• A
dv
ise re
: die
t/exe
rcise a
nd
de
term
ine
willin
gn
ess to
pa
rticipa
te in
a d
iab
ete
s pre
ven
tion
pro
gra
m
• If p
atie
nt a
gre
es to
pa
rticipa
te, p
roce
ed
with
refe
rral
ROO
MIN
G/V
ITALS
• C
alcu
late
BM
I (usin
g ta
ble
) an
d re
vie
w d
iab
ete
s risk score
• If e
lev
ate
d risk sco
re o
r histo
ry of G
DM
, fla
g fo
r po
ssible
refe
rral
CHECK
-IN•
If ag
e >_ 1
8 a
nd
pa
tien
t do
es n
ot h
ave d
iab
ete
s, pro
vid
e C
DC
Pre
dia
be
tes S
cree
nin
g Te
st or A
DA
Dia
be
tes R
isk Test
• P
atie
nt co
mp
lete
s test a
nd
retu
rns it
• In
sert co
mp
lete
d te
st in p
ap
er ch
art o
r no
te risk sco
re in
EM
R
MEA
SURE
ACT
PARTN
ER
* Som
e diab
etes preven
tion
pro
gram
pro
viders req
uire a B
MI o
f ≥2
5. Please ch
eck with
you
r
diab
etes preven
tion
pro
gram
pro
vider fo
r eligib
ility requ
iremen
ts.
>_
– 2
0 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Po
int-o
f-care
pre
dia
be
tes id
en
tifica
tion
Co
mm
un
icate
with
you
r loca
l dia
be
tes p
reve
ntio
n p
rog
ram
.
Co
ntact p
atien
t and
trou
ble
sho
ot issu
es w
ith e
nro
llme
nt o
r particip
ation
. At th
e n
ext
visit, ask patie
nt ab
ou
t pro
gre
ss and
en
cou
rage
con
tinu
ed
particip
ation
in th
e p
rog
ram.
Ad
apte
d fro
m: N
ew Yo
rk State Dep
artmen
t of H
ealth. N
ew Yo
rk State Diab
etes Preven
tion
Pro
gram
(NY
S DD
P)
pre
diab
etes iden
tificatio
n an
d in
terventio
n alg
orith
m. N
ew Yo
rk: NY
Dep
artmen
t of H
ealth; 2012
.
Order one of the tests below
:•
He
mo
glo
bin
A1
C (H
bA
1C
)
• Fa
sting
pla
sma
glu
cose
(FP
G)
• O
ral g
luco
se to
lera
nce
test (O
GT
T)
If n
o: P
atie
nt d
oe
s no
t curre
ntly m
ee
t
pro
gra
m e
ligib
ility req
uire
me
nts
MEA
SURE
Diagnostic test
Norm
alPrediabetes
Diabetes
Hb
A1
C(%
)<
5.7
5.7
–6
.4≥
6.5
Fastin
g p
lasm
a g
luco
se (m
g/d
L)<
10
01
00
–1
25
≥ 1
26
Ora
l glu
cose
tole
ran
ce te
st (mg
/dL)
<1
40
14
0–
19
9≥
20
0
PARTN
ER
ACT
RESU
LTSYES
If pa
tien
t is ag
e ≥
18
an
d d
oe
s no
t have
dia
be
tes, p
rov
ide
self-scre
en
ing
test
(CD
C P
red
iab
ete
s Scre
en
ing
Test o
r AD
A D
iab
ete
s Risk Te
st)
If self-scre
en
ing
test re
vea
ls risk, p
roce
ed
to n
ext ste
p
NO
Re
vie
w m
ed
ical re
cord
to d
ete
rmin
e if B
MI ≥
24
* (≥2
2 if A
sian
) or h
istory o
f GD
M**
De
term
ine
if a H
bA
1C
, FP
G o
r OG
TT
wa
s pe
rform
ed
in th
e p
ast 1
2 m
on
ths
Re
fer to
dia
be
tes p
reve
ntio
n
pro
gra
m, p
rov
ide
bro
chu
re.
Co
nsid
er re
testin
g a
nn
ua
lly
to ch
eck fo
r dia
be
tes o
nse
t.
En
cou
rag
e p
atie
nt to
ma
inta
in a
he
alth
y lifestyle
.
Co
ntin
ue
with
exa
m/
con
sult. R
ete
st with
in th
ree
yea
rs of la
st ne
ga
tive te
st.
Co
nfi
rm d
iag
no
sis;
rete
st if ne
cessa
ry.
Co
un
sel p
atie
nt
re: d
iag
no
sis.
Initia
te th
era
py.
NO
YES
* Som
e diab
etes preven
tion
pro
gram
pro
viders req
uire a B
MI o
f ≥2
5. Please ch
eck with
you
r diab
etes
preven
tion
pro
gram
pro
vider fo
r eligib
ility requ
iremen
ts.
** Histo
ry of G
DM
= elig
ibility fo
r diab
etes preven
tion
pro
gram
– 2
1 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Method 1:
Point-of-care identification and referralD
ownload and display patient m
aterialsD
ow
nlo
ad
an
d p
rint th
e p
ractice
an
d p
atie
nt re
sou
rces in
clud
ed
in th
is gu
ide
in a
dv
an
ce o
f pa
tien
t visits, so
you
r offi
ce ca
n
have
the
m av
aila
ble
in th
e w
aitin
g ro
om
or d
urin
g co
nsu
lt.
Measure
Step 1 – During check-in: If a
ge
≥1
8 a
nd
pa
tien
t do
es n
ot h
ave d
iab
ete
s, give
him
/he
r the
“CD
C P
red
iab
ete
s Scre
en
ing
Test ” o
r Am
erica
n D
iab
ete
s Asso
ciatio
n “D
iab
ete
s Risk Te
st”. Afte
r pa
tien
t com
ple
tes th
e te
st an
d re
turn
s it, inse
rt com
ple
ted
test in
the
pa
pe
r cha
rt or n
ote
risk score
in th
e e
lectro
nic m
ed
ical re
cord
(EM
R). S
cree
nin
g te
st can
also
be
ma
iled
to p
atie
nt
alo
ng
with
oth
er p
re-v
isit ma
teria
ls.
Step 2 – During room
ing/vitals: Calcu
late th
e p
atien
t’s bo
dy m
ass ind
ex. M
ost E
MR
s can calcu
late B
MI au
tom
atically. Re
view
the
patie
nt’s d
iabe
tes risk sco
re an
d if e
levate
d (≥
5 o
n A
DA
test o
r ≥9
on
CD
C te
st), flag
for p
ossib
le re
ferral.
Step 3 – During exam
/consult: Follo
w th
e “P
oin
t-of-ca
re p
red
iab
ete
s ide
ntifi
catio
n a
lgo
rithm
” to d
ete
rmin
e if p
atie
nt h
as
pre
dia
be
tes.
If the
blo
od
test re
sults do not in
dica
te p
red
iab
ete
s:
En
cou
rag
e th
e p
atie
nt to
ma
inta
in h
ea
lthy life
style ch
oice
s. Co
ntin
ue
with
exa
m/co
nsu
lt.
Act
A. If th
e p
atie
nt scre
en
s po
sitive fo
r pre
dia
be
tes a
nd
ha
s BM
I <2
4* (<
22
if Asia
n):
–
In
trod
uce
the
top
ic of p
red
iab
ete
s by b
riefl
y exp
lain
ing
wh
at it is a
nd
its rela
tion
to d
iab
ete
s (use
the
ha
nd
ou
t “ So
you
have
pre
dia
be
tes …
no
w w
ha
t?”). Re
vie
w th
e p
atie
nt’s o
wn
risk facto
rs.
–
E
mp
ha
size th
e im
po
rtan
ce o
f pre
ve
ntio
n, in
clud
ing
he
alth
y ea
ting
, incre
ase
d p
hysica
l activ
ity, an
d th
e e
limin
ation
of
risky drin
king
and
tob
acco u
se. (V
isit the
Natio
nal D
iabe
tes E
du
cation
Pro
gram
’s GA
ME
PLA
N to
Pre
ven
t Type
2 D
iabe
tes
for ad
ditio
nal p
atien
t reso
urce
s.)
B.
If the
pa
tien
t scree
ns p
ositive
for p
red
iab
ete
s an
d h
as B
MI ≥
24
* (≥2
2 if A
sian
):
–
Fo
llow
the
step
s in “A
” ab
ove
, discu
ss the
va
lue
of p
articip
atin
g in
a d
iab
ete
s pre
ven
tion
pro
gra
m, a
nd
de
term
ine
the
pa
tien
t’s willin
gn
ess to
let yo
u re
fer h
im/h
er to
a p
rog
ram
.
–
If th
e p
atie
nt a
gre
es, co
mp
lete
an
d se
nd
the
refe
rral fo
rm to
a co
mm
un
ity-ba
sed
or o
nlin
e d
iab
ete
s pre
ven
tion
pro
gra
m, d
ep
en
din
g o
n p
atie
nt p
refe
ren
ce.
–
If p
atie
nt d
eclin
es, o
ffe
r him
/he
r a p
rog
ram
ha
nd
ou
t an
d re
-ev
alu
ate
risk facto
rs at n
ext clin
ic visit.
Step 4 – Referral to diabetes prevention program: M
ost d
iabe
tes p
reve
ntio
n p
rog
rams are
con
fig
ure
d to
rece
ive re
ferrals via
con
ven
tion
al fax (ove
r a ph
on
e lin
e) o
r secu
re e
mail. C
om
ple
te th
e re
ferral fo
rm an
d su
bm
it to a p
rog
ram as fo
llow
s:
A. If u
sing
a p
ap
er re
ferra
l form
, sen
d v
ia fa
x (ove
r a p
ho
ne
line
) or sca
n a
nd
em
ail
B. If th
e re
ferra
l form
is em
be
dd
ed
in yo
ur E
MR
, eith
er fa
x (ove
r a p
ho
ne
line
) or e
ma
il usin
g th
e E
MR
–
S
om
e d
iab
ete
s pre
ven
tion
pro
gra
ms ca
n a
lso re
ceive
an
e-fa
x (ove
r the
Inte
rne
t)
Ph
ysician
s an
d o
the
r he
alth
care
pro
vid
ers sh
ou
ld a
lso u
se th
eir in
de
pe
nd
en
t jud
gm
en
t wh
en
refe
rring
to a
dia
be
tes
pre
ven
tion
pro
gra
m.
PartnerStep 5 – Follow
-up with patient: C
on
tact p
atie
nt a
nd
trou
ble
sho
ot issu
es w
ith e
nro
llme
nt o
r pa
rticipa
tion
. At th
e n
ext
visit, a
sk pa
tien
t ab
ou
t pro
gre
ss an
d e
nco
ura
ge
con
tinu
ed
pa
rticipa
tion
in th
e p
rog
ram
.
* So
me
dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
ers re
qu
ire a
BM
I of ≥
25
. Ple
ase
che
ck with
you
r dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
er fo
r
elig
ibility re
qu
irem
en
ts.
Re
ferrin
g p
atie
nts to
a d
iab
ete
s pre
ve
ntio
n p
rog
ram
– 2
2 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Re
trosp
ectiv
e p
red
iab
ete
s ide
ntifi
catio
n
Qu
ery E
MR
or p
atie
nt d
ata
ba
se e
very 6
–1
2 m
on
ths u
sing
the
follo
win
g crite
ria:
A. In
clusio
n crite
ria:
–
A
ge
≥1
8 ye
ars and
–
M
ost re
cen
t BM
I ≥2
4* (≥
22
if Asia
n) and
–
A
po
sitive la
b te
st resu
lt with
in p
rev
iou
s 12
mo
nth
s:
• H
bA
1C
5.7
–6
.4%
(LOIN
C co
de
45
48
-4) or
• F
PG
10
0–
12
5 m
g/d
L (LOIN
C co
de
15
58
-6) or
• O
GT
T 1
40
–1
99
mg
/dL (LO
INC
cod
e 6
28
56
-0) or
–
H
istory o
f ge
statio
na
l dia
be
tes (IC
D-9
: V1
2.2
1)
B
. E
xclusio
n crite
ria:
–
C
urre
nt d
iag
no
sis of d
iab
ete
s (ICD
-9: 2
50
.xx) or
–
Cu
rren
t Insu
lin u
se
Ge
ne
rate
a list o
f pa
tien
t na
me
s with
rele
va
nt in
form
atio
n
Use
the
pa
tien
t list to:
A. C
on
tact p
atie
nts to
info
rm o
f risk statu
s, exp
lain
pre
dia
be
tes, a
nd
sha
re in
fo o
n
dia
be
tes p
reve
ntio
n p
rog
ram
s, and/or
B. S
en
d p
atie
nt in
fo to
dia
be
tes p
reve
ntio
n p
rog
ram
pro
vid
er
–
P
rog
ram
coo
rdin
ato
r will co
nta
ct pa
tien
t dire
ctly, and
C. Fla
g m
ed
ical re
cord
for p
atie
nt’s n
ext o
ffice
visit
Discu
ss pro
gra
m p
articip
atio
n a
t ne
xt v
isit
MEA
SURE
ACT
PARTN
ER
* Som
e diab
etes preven
tion
pro
gram
pro
viders req
uire a B
MI o
f ≥2
5. Please ch
eck with
you
r diab
etes
preven
tion
pro
gram
pro
vider fo
r eligib
ility requ
iremen
ts.
– 2
3 –
Th
e A
me
rican M
ed
ical Asso
ciation
and
the
Ce
nte
rs for D
isease
Co
ntro
l are su
pp
ortin
g p
hysician
s, care te
ams an
d p
atien
ts to p
reve
nt d
iabe
tes.
Method 2:
Retrospective identification and referral Step 1 – Q
uery EMR or patient database
Measure
Qu
ery yo
ur E
MR
or p
atie
nt d
ata
ba
se e
very 6
–1
2 m
on
ths u
sing
the
follo
win
g crite
ria:
A. In
clusio
n crite
ria:
–
A
ge
≥1
8 ye
ars and
–
B
MI ≥
24
* (≥2
2 if A
sian
) and
–
A
po
sitive te
st resu
lt for p
red
iab
ete
s with
in th
e p
rece
din
g 1
2 m
on
ths:
• H
bA
1C
5.7
–6
.4%
or
•
Fastin
g p
lasm
a g
luco
se 1
00
–1
25
mg
/dL or
• O
ral g
luco
se to
lera
nce
test 1
40
–1
99
mg
/dL or
–
C
linica
lly dia
gn
ose
d g
esta
tion
al d
iab
ete
s du
ring
a p
rev
iou
s pre
gn
an
cy
B.
Exclu
sion
criteria
:
–
C
urre
nt d
iag
no
sis of d
iab
ete
s or
–
Cu
rren
t Insu
lin u
se
Ge
ne
rate
a list o
f pa
tien
t na
me
s an
d o
the
r info
rma
tion
req
uire
d to
ma
ke re
ferra
ls:
–
G
en
de
r an
d b
irth d
ate
–
E
ma
il ad
dre
ss
–
M
ailin
g a
dd
ress
–
Ph
on
e n
um
be
r
Act
Step 2 – Referral to diabetes prevention programA
. Co
nta
ct pa
tien
ts via
ph
on
e, e
ma
il, lette
r or p
ostca
rd to
exp
lain
the
ir pre
dia
be
tes sta
tus a
nd
let th
em
kn
ow
ab
ou
t the
dia
be
tes p
reve
ntio
n p
rog
ram
.
B.
Se
nd
rele
va
nt p
atie
nt in
form
atio
n to
you
r loca
l (or o
nlin
e) d
iab
ete
s pre
ven
tion
pro
gra
m co
ord
ina
tor a
nd
have
him
/he
r
con
tact th
e p
atie
nt d
irectly (m
ay req
uire
Bu
sine
ss Asso
ciate
Ag
ree
me
nt).
C. Fla
g p
atie
nts’ m
ed
ical re
cord
s for th
eir n
ext o
ffice
visit.
Ph
ysician
s an
d o
the
r he
alth
care
pro
vid
ers sh
ou
ld a
lso u
se th
eir in
de
pe
nd
en
t jud
gm
en
t wh
en
refe
rring
to a
dia
be
tes
pre
ven
tion
pro
gra
m.
PartnerD
urin
g th
e n
ex
t offi
ce v
isit, discu
ss dia
be
tes p
reve
ntio
n p
rog
ram
pa
rticipa
tion
:
–
If th
e p
atie
nt is p
articip
atin
g, d
iscuss p
rog
ram
exp
erie
nce
an
d e
nco
ura
ge
con
tinu
ed
pa
rticipa
tion
–
If th
e p
atie
nt h
as d
eclin
ed
to p
articip
ate
, stress th
e im
po
rtan
ce o
f lifestyle
cha
ng
e a
nd
con
tinu
e to
en
cou
rag
e
pa
rticipa
tion
(use
the
ha
nd
ou
t “So
you
have
pre
dia
be
tes …
no
w w
ha
t?”)
* Som
e diab
etes preven
tion
pro
gram
pro
viders req
uire a B
MI o
f ≥2
5. Please ch
eck with
you
r diab
etes preven
tion
pro
gram
pro
vide
r for elig
ibility
requ
iremen
ts.
– 2
4 –
PATIENT IN
FORM
ATION
First na
me
Ad
dre
ss
Last n
am
e
He
alth
insu
ran
ceC
ity
Ge
nd
er
Ma
le
Fem
ale
Sta
te
Birth
da
te (m
m/d
d/y
y)Z
IP co
de
Em
ail
Ph
on
e
By p
rovid
ing
you
r info
rmatio
n ab
ove, yo
u au
tho
rize you
r health
care practitio
ner to
pro
vide th
is info
rmatio
n to
a diab
ete
s
pre
ven
tion
pro
gram
pro
vide
r, wh
o m
ay in tu
rn u
se th
is info
rmatio
n to
com
mu
nicate
with
you
reg
ardin
g its d
iabe
tes
pre
ven
tion
pro
gram
.
PRACTITION
ER INFO
RMATIO
N (CO
MPLETED
BY HEALTH
CARE PRACTITION
ER)
Ph
ysician
/NP
/PAA
dd
ress
Pra
ctice co
nta
ctC
ity
Ph
on
eS
tate
Fax
ZIP
cod
e
SCREENIN
G IN
FORM
ATION
Bo
dy M
ass In
de
x (BM
I) (E
ligib
ility = ≥
24
* (≥2
2 if A
sian
)
Blo
od
test (ch
eck o
ne
)E
ligib
le ra
ng
eTe
st resu
lt (on
e o
nly)
� H
em
og
lob
in A
1C
5
.7–
6.4
%
__
__
__
__
__
__
__
__
__
__
_
� Fa
sting
Pla
sma
Glu
cose
10
0–
12
5 m
g/d
L_
__
__
__
__
__
__
__
__
__
__
� 2
-ho
ur p
lasm
a g
luco
se (7
5 g
m O
GT
T)
14
0–
19
9 m
g/d
L_
__
__
__
__
__
__
__
__
__
__
Da
te o
f blo
od
test (m
m/d
d/y
y):
For M
ed
icare
req
uire
me
nts, I w
ill ma
inta
in th
is sign
ed
orig
ina
l do
cum
en
t in th
e p
atie
nt’s m
ed
ical re
cord
.
By sig
nin
g th
is form
, I au
tho
rize m
y ph
ysician
to d
isclose
my d
iab
ete
s scree
nin
g re
sults to
the
(inse
rt
pro
gra
m/o
rga
niza
tion
na
me
he
re) fo
r the
pu
rpo
se o
f de
term
inin
g m
y elig
ibility fo
r the
dia
be
tes
pre
ven
tion
pro
gra
m a
nd
con
du
cting
oth
er a
ctivitie
s as p
erm
itted
by law
.
I un
de
rstan
d th
at I a
m n
ot o
blig
ate
d to
pa
rticipa
te in
this d
iab
ete
s scree
nin
g p
rog
ram
an
d th
at th
is
au
tho
rizatio
n is vo
lun
tary.
I un
de
rstand
that I m
ay revo
ke th
is auth
orizatio
n at an
y time
by n
otifyin
g m
y ph
ysician in
writin
g.
An
y revo
cation
will n
ot h
ave an
eff
ect o
n actio
ns take
n b
efo
re m
y ph
ysician re
ceive
d m
y writte
n re
vocatio
n.
IMP
OR
TAN
T WA
RN
ING
: The d
ocu
men
ts accom
pan
ying
this tran
smissio
n co
ntain
con
fid
ential h
ealth in
form
ation
pro
tected fro
m u
nau
tho
rized u
se or
disclo
sure excep
t as perm
itted b
y law. Th
is info
rmatio
n is in
tend
ed o
nly fo
r the u
se of th
e ind
ividu
al or en
tity nam
ed ab
ove. Th
e auth
orized
recipien
t of
this in
form
ation
is pro
hib
ited fro
m d
isclosin
g th
is info
rmatio
n to
any o
ther p
arty un
less perm
itted to
do
so b
y law o
r regu
lation
. If you
are no
t the in
tend
ed
recipien
t and
have received
this in
form
ation
in erro
r, please n
otify th
e send
er imm
ediately fo
r the retu
rn o
r destru
ction
of th
ese do
cum
ents. R
ev. 05/30/14
* Som
e diab
etes preven
tion
pro
gram
pro
viders req
uire a B
MI o
f ≥2
5. Please ch
eck with
you
r diab
etes preven
tion
pro
gram
pro
vide
r for elig
ibility
requ
iremen
ts.
Date
Practitioner signature
He
alth
care
pra
ctition
er re
ferra
l form
to a
dia
be
tes
pre
ve
ntio
n p
rog
ram
Send to: Fax:
Email:
Date
Patient signature
OPTIONAL
– 25 –
BMI stands for “BODY MASS INDEX” which is an estimate of total body fat based on height and weight. It is used to screen for weight categories that may lead to health problems.
THE GOAL for most people is to have a BMI in the green area. It is usually best for your BMI to stay the same over time or to gradually move toward the green area.
WEIGHTHEIGHT5'0" 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 555'1" 18 20 22 24 26 28 30 32 34 36 37 39 42 44 45 47 49 51 535'2" 18 20 22 23 25 27 29 31 33 34 36 38 40 42 44 46 48 50 515'3" 17 19 21 23 24 26 28 30 32 33 35 37 39 41 43 44 46 48 505'4" 17 18 20 22 24 25 27 29 31 32 34 36 38 40 41 43 45 46 485'5" 16 18 20 21 23 25 26 28 30 31 33 35 37 38 40 42 43 45 475'6" 16 17 19 21 22 24 25 27 29 30 32 34 36 37 39 40 42 44 455'7" 15 17 18 20 22 23 25 26 28 29 31 33 35 36 38 39 41 42 445'8" 15 16 18 19 21 22 24 25 27 28 30 32 34 35 37 38 40 41 435'9" 14 16 17 19 20 22 23 25 26 28 29 31 33 34 36 37 39 40 415'10" 14 15 17 18 20 21 23 24 25 27 28 30 32 33 35 36 37 39 405'11" 14 15 16 18 19 21 22 23 25 26 28 29 31 32 34 35 36 38 396'0" 13 14 16 17 19 20 21 23 24 25 27 28 30 31 33 34 35 37 386'1" 13 14 15 17 18 19 21 22 23 25 26 27 29 30 32 33 34 36 376'2" 12 14 15 16 18 19 20 21 23 24 25 27 28 30 31 32 33 35 366'3" 12 13 14 16 17 18 19 21 22 23 24 26 28 29 30 31 33 34 356'4" 12 13 14 15 17 18 19 20 21 23 24 26 27 28 29 31 32 33 346'5" 11 13 14 15 16 17 19 20 21 22 24 25 26 27 29 30 31 32 33
Blue Underweight: Less than 18.5 Green Healthy Weight: 18.5 - 24.9 Yellow Overweight: 25 - 29.9 Orange Obese: 30 - 39.9 Red Extreme Obesity: 40 or greater
57 59 61 63 65 67 69 71 72 74 76 7855 57 59 61 63 64 66 68 70 72 74 7653 55 57 59 61 62 64 66 68 70 72 7352 53 53 57 59 60 62 64 66 67 69 7150 52 53 55 57 59 60 62 64 65 67 6948 50 52 53 55 57 58 60 62 63 65 6747 49 50 52 53 55 57 58 60 62 63 6546 47 49 50 52 53 55 57 58 60 61 6344 46 47 49 50 52 53 55 56 58 59 6143 44 46 47 49 50 52 53 55 56 58 5942 43 45 46 47 49 50 52 53 55 56 5841 42 43 45 46 48 49 50 52 53 55 5639 41 42 44 45 46 48 49 50 52 53 5438 39 41 42 44 45 46 48 49 50 52 5337 39 40 41 42 44 45 46 48 49 50 5136 38 39 40 41 43 44 45 46 48 49 5035 37 38 39 40 41 43 44 45 46 48 4934 36 37 38 39 40 42 43 44 45 46 48
290 300 310 320 330 340 350 360 370 380 390 400250 260 270 280100 110 120 130 140 150 160 170 180 190 200 210 220 230 240WEIGHT
BMI calculation chart
– 2
6 –
Codes for prediabetes and diabetes screening*,†,‡
International Classification of Diseases (ICD
)-9 for diabetes screeningCurrent Procedural Term
inology (CPT®) for diabetes screening tests
V77.1
Dia
be
tes S
cree
nin
gCPT 82947
Fastin
g P
lasm
a
Glu
cose
Test
790.2A
bn
orm
al G
luco
seCPT 82950
Po
st-me
al G
luco
se
(2-h
ou
r pla
sma
glu
cose
;
2h
PG
; 2 h
r spe
cime
n)
790.21Im
pa
ired
Fastin
g G
luco
seCPT 82951
Ora
l Glu
cose
Tole
ran
ce
(3 sp
ecim
en
s with
2 h
r va
lue
inclu
de
d)
790.22Im
pa
ired
Glu
cose
Tole
ran
ce (o
ral)
CPT 83036H
em
og
lob
in A
1C
790.29O
the
r Ab
no
rma
l Glu
cose
NE
C
CPT 83036QW
H
em
og
lob
in A
1C
(use
d fo
r PO
C te
st tha
t is
CLIA
wa
ived
[~D
CA
])
278.00O
be
sity
278.02O
verw
eig
ht
These codes may be useful to report services/tests perform
ed to screen for prediabetes and diabetes.
Referen
ces
* New
York State D
epartm
ent o
f Health
. New
York State D
iabetes P
reventio
n P
rog
ram (N
YS D
PP) p
rediab
etes iden
tificatio
n an
d in
terventio
n alg
orith
m. N
ew
York: N
Y D
ept o
f Health
; 2012.
† Am
erican D
iabetes A
ssociatio
n. Stan
dard
s of m
edical care in
diab
etes—2013
. Diab
etes Care. Jan
uary 2013; 3
6:S11-6
6. d
oi: 10.2
337/dc13
-S011
‡ Ackerm
ann
RT. C
od
ing
Gu
ide fo
r Diab
etes and
Pred
iabetes Testin
g. 2013. (P
ub
lished
here w
ith p
ermissio
n fro
m R
on
ald T. A
ckerman
n M
D, M
PH
.)
Co
de
s: Wh
en
scree
nin
g fo
r pre
dia
be
tes a
nd
dia
be
tes
© 2
015 A
me
rican M
ed
ical Asso
ciation
. CP
T is cop
yrigh
t 20
14
Am
erican
Me
dical A
ssociatio
n. A
ll righ
ts rese
rved
.