Improving Adherence to Prediabetes Clinical Practice Recommendations in a Primary Care Health Professional Shortage Area
Graduate Degree Type
College of Nursing
Della Hughes-Carter, DNP, RN, GNP-BC
Dianne Conrad, DNP, RN, FNP-BC
Background: Type 2 diabetes is a growing problem that is associated with increased mortality and considerable economic burden. Early identification and intervention in prediabetes can prevent or delay the progression to type 2 diabetes. Evidence-based clinical practice recommendations provide a framework for identification, diagnosis, and management of prediabetes; however, adherence among primary care providers is low.
Objectives: This quality improvement project was designed to increase provider adherence to prediabetes clinical practice recommendations through the use of a point-of-care screening and referral method. The project aimed to improve provider knowledge of prediabetes and increase screening and referral behaviors.
Methods: A point-of-care screening and referral method was implemented at a primary care practice in the Midwest. Outcome measures for provider knowledge, screening, and referral behaviors were compared using pre- and post-implementation data collected over 8-week intervals. Data was analyzed using statistical methods (alpha = .05) and calculations for absolute and relative change.
Results: Provider knowledge of prediabetes screening, diagnosis, and referral to the Diabetes Prevention Program (DPP) improved. There was a statistically significant increase in screening practices (p-value = 0.006); however, a weak association between the variables suggests that the increase cannot be attributed to the intervention (Cramer’s V = .063). Provider referral to the DPP demonstrated no significant change (p-value = 0.624).
Conclusions: Despite an improvement in provider knowledge, the point-of-care method did not have a significant impact on prediabetes screening and referral to the DPP. Important project limitations were identified related to the methodology for measurement and data collection. The change in provider knowledge and recommendations to improve methodology for future analysis were clinically significant findings.
Implications: The project demonstrates the need to address barriers to DPP referral. There are also implications for future clinical inquiry and the development of quality measures that focus on prediabetes.
Monette, Autumn, "Improving Adherence to Prediabetes Clinical Practice Recommendations in a Primary Care Health Professional Shortage Area" (2023). Culminating Experience Projects. 296.
Available for download on Thursday, April 30, 2026