1. Geisinger Obesity Institute
Communicating Personalized Diabetes Risk with Options for Weight Management: Recruitment, Enrollment, and Outcomes

3. Treatment for pre-diabetes
Diabetes prevention program*:
Intensive lifestyle intervention reduced incidence of diabetes by 58%.
16 lesson curriculum covering diet, exercise, and behavior modification
Goal of 7% weight loss
Metformin treatment reduced incidence of diabetes by 31%.
*Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine. 2002;346(6):393–403.

4. If you build it, they will come? Or maybe not…
~Field of Dreams
1989
Suboptimal provider engagement
<33% receive weight management advice from PCP
<5% are referred for treatment
Low patient engagement
15% pursue weight management based on PCP recommendation

5. How do we get more patients to treatment?
Engagement strategies to get patients to treatment and to finish treatment.
(if you build it right, they will come and stay)
Personalization of their disease risk
Evidence that treatment improves future health
Let patient choose their treatment

6. Create personalized diabetes risk calculator
Methods:
Identified n=6620 patients with pre-diabetes (A1c %)
Retrospectively followed patients for 3 years
Identify time until progression to diabetes
Use multiple logistic regression to derive prediction equation
Examine effect modification of weight loss
Results:
BMI, sex, A1c, and weight loss were associated with diabetes progression (p< for each)
Age was not significant (p=0.8) but was retained in the model

7. Diabetes Risk Calculator (we built it)
Does weight loss influence risk of progression to diabetes?
Weight change in next year
Chance of diabetes in 3-years
Personalized risk
Female
Age = 45
Weight = 300
BMI = 42 kg/m2
HbA1c = 6.3%
Weight stable
51%
Evidence that treatment will decrease risk
Lose 15 pounds
41%
Lose 30 pounds
33%
Lose 45 pounds
25%

8. Preventing Type 2 Diabetes Study
Funding Support: GHP Quality Fund Pilot Project
Personalized Diabetes Risk Calculator
Home Letter
Weight Management Program
RD/RDN
DPP (Diabetes Prevention Program)
Pharm + RD
Pharm + DPP
Weight Watchers
Weight
A1c
Diabetes Risk Reduction
6 months
12 months
Choose treatment that meets their needs

9. Preventing Type 2 Diabetes Study
Current study questions (data source)
Will communication of personalized diabetes risk engage patients to pursue weight management? (Recruitment response rate)
Will patients be activated to participate in weight management program of choice? (Enrollment in program and completion rates)
What is the change in weight, A1c, and diabetes risk among cases? (change from baseline to 6-months)

10. Study questions Question Outcome
Will communication of personalized diabetes risk engage patients to pursue weight management?
Recruitment response rate
Will patients be activated to participate in weight management program of choice?
Enrollment in program and completion rates
Did intervention improve diabetes risk indicators?
Change in weight, A1c, and diabetes risk score from baseline to 6-months

11. Preventing Type 2 Diabetes Study
Methods:
Identify N=338 adults with BMI>27 kg/m2 and pre-diabetes (A1c )
Patients received letter with current risk of developing type 2 diabetes, estimated reduction with weight loss, and invited to enroll in free weight management program of choice, program information

12. Preventing Diabetes Study (they came)
Will communication of personalized diabetes risk engage patients to pursue weight management?
25% recruitment response rate (n=84 of 338)
A higher rate than expected!
DPP 27-site trial observed 6.6% recruitment response rate RR Rubin et al. Control Clin Trials 2002;23:157–171.
DEPLOY trial observed 7.1% recruitment response rate. RT Ackermann et al. AJPM. 2008;35(4):
Characteristic
Sample
Age
58.9 y (30-75)
Sex
48% Male
BMI
34.8
A1c
5.99
Diabetes Risk
23.5%

13. Preventing Diabetes Study (and stayed)
Program
Participant Choice
Participants Completed initial Session
Participants Completing ≥ ¾ Sessions*
RD: Telephone counseling with a Dietitian, FitBit, and BMIQ website portal
31%
96%
76%
DPP: Diabetes Prevention Program (DPP)
15%
100%
77%
MEDS+RD: Pharmacologic Treatment plus RD
33%
92%
83%
MEDS+DPP: Pharmacologic Treatment plus DPP
11%
63%
WW: Weight Watchers
38% 0%
* Denominator: Participants completed initial session

14. Preventing Diabetes Study (and left with lower risk)
Preliminary results (N=55 with 6-month outcomes):
Weight loss
Mean WL% = 10.3%
78% lost >5% of initial body weight
Change in HbA1c
Mean decreased from 6.04% to 5.81%
71% decreased their HbA1c
Diabetes Risk Reduction
None progressed to diabetes
Risk decreased from 26.8% to 15.2%

15. Summary – A field of Dreams!
We built a diabetes risk calculator
Patients came to participate (2.5x higher rate than expected)
Most stayed for the duration of treatment
90% started and 74% of those completed treatment
And left with lower risk of progression to diabetes

16. Preventing Type 2 Diabetes Study
Dr. Rolston, WNEP Healthwatch: “Rather than say, go lose weight, we can now put a number to that weight, give them actual data to work with.”
Alli Naylor, RDN: "Most worthwhile is the difference our efforts are making in the lives of patients”
Patient quote: “I am so thankful for this program and the opportunity to improve my health”

17. Next Steps
Collect 12 month weights, A1c, study questionnaires (satisfaction, involvement in care, quality of life), Compare 3-year outcomes to controls (year 2021)
Integrate Diabetes Risk
Calculator into EPIC
(in process), study
implementation
strategies
EPIC provider view

18. Preventing Type 2 Diabetes Study Team
Dr. Lisa Bailey-Davis
Dr. Christopher Still
Dr. David Rolston
Scott Jamison
Jacob Mowery
Alli Naylor
Krystal Cunningham
Adam Cook
Chris Seiler
Craig Wood