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DP Participant Cases

DP Participant Cases. SDPI Diabetes Prevention Initiative Program. Participant #1. A 37 year old man is referred by the Clinic to participate in your DP program. A review of his medical record shows a FBG of 140mg/dl 3 months ago and a repeat FBG done 3 weeks ago that is 115mg/dl .

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DP Participant Cases

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  1. DP Participant Cases SDPI Diabetes Prevention Initiative Program

  2. Participant #1 • A 37 year old man is referred by the Clinic to participate in your DP program. • A review of his medical record shows a FBG of 140mg/dl 3 months ago and a repeat FBG done 3 weeks ago that is 115mg/dl. • Is he eligible to participate in your program? • What if his FBG done 3 weeks ago was 126mg/dl? • What if a HgA1c done 3weeks ago was 6.5%?

  3. Participant #1, cont. • What other tests would you consider doing at this time? • Your team decides to repeat a glycemic measurement. Which one would you choose? • A FBG is done the following day and is 120mg/dl. • Is he eligible to participate? • What if his FBG is 129mg/dl? What would you do then?

  4. DP Screening and Eligibility Core Element Prediabetes ranges: • Fasting blood glucose 100-125 mg/dl (Impaired Fasting Glucose, IFG) • 2-hour glucose 140-199 mg/dl (Impaired Glucose Tolerance, IGT) • A1c > 5.7 and < 6.5 (note: this remains an area of controversy for the diabetes community. Our best evidence suggests this cut-off at this time.)

  5. DP Screening and Eligibility Core Element • For individuals who have an FBG> 126mg/dl, a 2-hour glucose > 200mg/dl, or an A1c ≥ 6.5, a repeat glycemic measure must be done on a different day, within 7 days of the initial glycemic measure, to rule out the presence of diabetes.

  6. Participant # 2 • A 25 year old woman comes to your Community event and is screened with a Random Capillary Glucose result of 108mg/dl. • What is your next step? • What would you do if her result was 320mg/dl? • After speaking to her, she is excited to join the program and you schedule her for a glycemic measurement. Which one would you choose? • She returns to the lab 6 days later and has a FBG drawn and the results are 105mg/dl? • Is she eligible to participate? • What if she doesn’t return for 3 weeks and a HgA1c is done with a result of 6.6%?

  7. Participant #2, cont. • What is your next step? • Which glycemic measurement would you choose? • A FBG is done 4 days after the HgA1c is drawn and the result is 110mg/dl? Is she eligible to participate in your program? • What would you do if her FBG is 200mg/dl?

  8. DP Screening and Eligibility Core Element • For individuals who have an FBG> 126mg/dl, a 2-hour glucose > 200mg/dl, or an A1c ≥ 6.5, a repeat glycemic measure must be done on a different day, within 7 days of the initial glycemic measure, to rule out the presence of diabetes.

  9. Participant #3 • A 66 year old man expresses an interest in joining your DP Program. • He has a history of severe lung disease and uses supplemental oxygen occasionally. • A FBG is done and the results are 210mg/dl. • You review his medical chart and find that he has recently been placed on oral steroids for his lung disease. • Does this impact the lab results? • What is your next step? • A repeat FBG is done 6 days later and is 140mg/dl. • What should you do next? • Is he eligible to participate?

  10. Participant #3, cont. • You speak to him and find out that he uses his oxygen around the clock now. • How will that impact his eligibility? • You speak to his physician who tells you that this individual must be enrolled in the program. • What options do you have?

  11. DP Screening and Eligibility Core Element • Exclude individuals from participation in this project with the following diagnoses/conditions: • Current diagnosis of pregnancy (reconsider participation 6 weeks after delivery; suspend participation if becomes pregnant during program) • Active alcohol or substance abuse that would affect successful participation (by provider judgment) • End Stage Renal Disease on dialysis • Previous diagnosis of diabetes (not eligible for diabetes prevention) • Current diagnosis of cancer undergoing treatment that prohibits participation (by provider judgment) • Any other significant or unusual condition or life situation that makes it likely that the participant will not be able to participate

  12. Participant #4 • A 32 year old woman sees your flyer in the Clinic and comes to your Program office wanting to enroll. • You schedule her for a glycemic measurement and she returns 2 days later for a HgA1c. • Her results are 6.1%. • Is she eligible to participate? • During your intake, she informs you that she thinks she may be pregnant. • What is your next step? • She returns to your office 2 weeks later and informs you that she is not pregnant. What is your next step?

  13. Participant #4, cont. • She begins to participate in the DP Program, but your staff notice she is gaining weight and appears to have a larger abdomen as time goes on. • What is your next step? • What if she has a miscarriage after beginning the Program?

  14. DP Screening and Eligibility Core Element • Exclude individuals from participation in this project with the following diagnoses/conditions: • Current diagnosis of pregnancy (reconsider participation 6 weeks after delivery; suspend participation if becomes pregnant during program) • Active alcohol or substance abuse that would affect successful participation (by provider judgment) • End Stage Renal Disease on dialysis • Previous diagnosis of diabetes (not eligible for diabetes prevention) • Current diagnosis of cancer undergoing treatment that prohibits participation (by provider judgment) • Any other significant or unusual condition or life situation that makes it likely that the participant will not be able to participate

  15. Participant #5 • A 49 year old woman is screened at one of your Community events and is found to have a Random Capillary Glucose of 116mg/dl? • What is your next step? • She comes in for her glycemic measurement 1 week later and has a FBG done with a result of 112mg/dl? • Is she eligible to participate? • During her participation in the DP Program, she informs your staff that she has just been diagnosed with breast cancer. • What is your next step?

  16. Participant #5, cont. • The participant undergoes a lumpectomy and chemotherapy. • Is she eligible to continue in the program? • What other information do you need? • Her primary care provider feels she is stable and can continue. What other information might you want to get? • Her oncologist follow up evaluation reveals that she has developed metastases. • Is she eligible to continue?

  17. DP Screening and Eligibility Core Element • Exclude individuals from participation in this project with the following diagnoses/conditions: • Current diagnosis of pregnancy (reconsider participation 6 weeks after delivery; suspend participation if becomes pregnant during program) • Active alcohol or substance abuse that would affect successful participation (by provider judgment) • End Stage Renal Disease on dialysis • Previous diagnosis of diabetes (not eligible for diabetes prevention) • Current diagnosis of cancer undergoing treatment that prohibits participation (by provider judgment) • Any other significant or unusual condition or life situation that makes it likely that the participant will not be able to participate

  18. Participant #6 • A 39 year old man with a past history of methamphetamine abuse is referred by his HCP to your program. • His HgA1c was done 2 weeks ago with a result of 5.9%. • Is he eligible to participate? • What other pertinent history would you like more information about? • He states he last smoked crystal meth 1 year ago and has been sober since.

  19. Participant #6 • He enrolls in the DP Program and participates fully in all activities for about 6 weeks. • Your staff begin to notice he is missing classes and appointments and his appearance and behavior have become more odd. • What is your next step? • Would you consider making this participant Inactive? • What if he admitted that he had started using crystal meth again “just on the weekends”?

  20. DP Screening and Eligibility Core Element • Exclude individuals from participation in this project with the following diagnoses/conditions: • Current diagnosis of pregnancy (reconsider participation 6 weeks after delivery; suspend participation if becomes pregnant during program) • Active alcohol or substance abuse that would affect successful participation (by provider judgment) • End Stage Renal Disease on dialysis • Previous diagnosis of diabetes (not eligible for diabetes prevention) • Current diagnosis of cancer undergoing treatment that prohibits participation (by provider judgment) • Any other significant or unusual condition or life situation that makes it likely that the participant will not be able to participate

  21. Participant #7 • A 21 year old man was screened in the clinic 1 year ago and found to have a FBG of 109mg/dl. • His HCP diagnosed him with “Prediabetes”. • The individual is lost to follow up by the clinic until 2 weeks ago and is referred for participation in your program. • Is he eligible to participate? • What is the next step? • A HgA1c is done 1 week after he agrees to participate and the results are 5.5%. • Is he eligible?

  22. Participant #7, cont. • What if his HgA1c is 6.6%? • It is determined that he is eligible to participate, and the next scheduled DPP Curriculum Class is 2 weeks away. • The individual is again lost to follow up and returns 3 months later. • What is your next step? • What would you do if he is unable to participate in the next scheduled DPP Curriculum Class but can return for the one you have scheduled in 2 months?

  23. DP Screening and Eligibility Core Element • If a person has previously had a positive test for prediabetes, and the repeat test now is normal, they are still considered to have prediabetes from the original diagnosis and are still eligible to participate. • For the purposes of this project, if you find someone with pre-existing prediabetes, you should test them with an FBG, OGTT or A1c in the month before starting DPP classes to make sure that they haven’t developed diabetes before enrolling them in the project.

  24. Participant #8 • A 54 year old woman has been screened, had her glycemic measurement done and is eligible for participation in your DP program. • Her baseline assessment is done and a Urine AC ratio is obtained with results of 55mg/g creatinine. • What do you think of these results? • What is your next step? • A repeat Urine AC ratio is obtained at the request of her HCP and the results are 65mg/g creatinine. • What should you do next?

  25. Urine AC Ratio • Typically recommended test for individuals diagnosed with diabetes to follow renal function. • However, studies have shown that there may be a correlation between elevated urine albumin (> 30mg/g of creatinine) and an increased CVD risk in individuals without diabetes. • The Funding Opportunity Agreement (FOA) Section II B, Award Recipient Responsibilities indicates it is one of the required elements of the DP Initiatives Project. • Serial testing not recommended for the purposes of the DP Initiative project, BUT any individual found to have an elevated UACR (> 30mg/g creatinine) should be referred to their health care provider for further evaluation. From: www.ihs.gov

  26. THE END! The End

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