2019-P: Leveraging the Electronic Health Record to Improve Awareness and Referrals of Older Adults with Prediabetes to the National Diabetes Prevention Program: A Quality Care Initiative

Introduction and Objective: Type 2 diabetes (T2D)-related morbidity and mortality are high among older adults. The National Diabetes Prevention Program (DPP) is a lifestyle intervention that reduces T2D risk by over 50%, with greater benefit among older adults. In partnership with the ADA’s Diabetes Prevention Alliance, we implemented a quality improvement initiative to increase awareness of, and referral to, the National DPP among older adults with prediabetes across Duke Health. Methods: During Phase 1 (October 2024-June 2025), we conducted in-person outreach to four primary care clinics and provided in-person education and printed “DPP prescription pads” to distribute to patients. Phase 1 did not increase self-referral rates. During Phase 2 (July-October 2025), we built an electronic health record (EHR) workflow that automatically sent messages to older adults with prediabetes containing information about the National DPP and a self-enrollment link (via the ADA website). Results: Messages were sent to 13,510 patients (61% female, 70% White, 95% non-Hispanic); 70% (n=9455) opened the message, but engagement declined at subsequent steps: 6% (n=806) clicked the ADA website link, 2% (n=280) completed an online diabetes risk test, 0.08% (n=11) submitted a self-referral form, and fewer than .01% (n=1) enrolled in a DPP class. Race was significantly associated with link engagement (χ²(6)=38.71, p<.001), with highest engagement among White patients, followed by Black and Asian patients. No associations were observed with sex or ethnicity. Conclusion: Automated EHR messaging is a scalable, low-resource public health strategy to disseminate information about prediabetes and the DPP. However, substantial drop-off from message engagement to enrollment suggests additional system-level supports are needed to convert outreach to participation.