An Investigation of Physician Communication and Medication Use in Prediabetes and the Prevention of Diabetes

An Investigation of Physician Communication and Medication Use in Prediabetes and the Prevention of Diabetes

Author: 
Sharon Hatch
Program of study: 
D.H.A.
Abstract: 
Diabetes is one of the major causes of death and disability throughout the world with an annual cost of managing the estimated 25.8 million diabetics in the United States between $174 and $245 billion. The purpose of this study was to examine the relationship between physician communication of a diagnosis of prediabetes and the onset of diabetes. The second purpose was to examine the relationship between initiation of treatment with medication in individuals with prediabetes and the onset of diabetes. Purposive sampling included three (3) years (July 2012 to June 2015) of a national managed care company’s Florida (fully-funded) commercial, Medicare, and Medicaid plans archival data. All members with a diagnosis of prediabetes that had at least 35 continuous months of enrollment between July 2012 and June 2015 were included in the sample. The Health Belief Model was utilized for this study to put in perspective potential patient and physician reasons for initiating or not initiating interventions to prevent diabetes in individuals with prediabetes. A relationship between physician communication of a diagnosis of prediabetes and use of medication in prediabetes with the onset of diabetes could not be calculated as a most basic assumption, that providers screened members for prediabetes, was false. Key recommendations, as a result, are to increase screening for prediabetes for at-risk populations, improve coding options in future iterations of coding rules, and reconsider the diagnosis of prediabetes as a precursor to diabetes and merge the definitions to improve identification at the time of likely initial beta cell dysfunction.
Dedication: 
My dissertation journey has been a long one, with many distractions, challenges, competing priorities, and life altering experiences. It has also been incredibly exciting and fulfilling, and much more than I bargained for in every way. I am forever grateful to my husband Jon who saw me through all of it. Jon, you endured many nights of take-out dinner, yelling at my computer, and schoolwork in all sorts of crazy places like on cruise ships, in hospitals, and during hurricanes. Yet you kept your sense of humor so I could keep moving forward. Your Dr. Honey loves you very much! To my amazing, beautiful, brilliant, and hysterically funny daughter Sydney; I started school when you were a toddler, and now you are approaching double digits vigorously, with curiosity and kindheartedness; I did this for you as much as me. Things in life may not always come easy, but no matter what they are, we can overcome them. You are only as limited as you think, fail forward and you will triumph. I love you both to infinity! To my parents, Linda and Edward, I could not have done this without your unwavering and boundless support, belief, and of course, babysitting services. In moments I was too exhausted to function, you impelled me to the finish line. I will never be able to thank you enough, and cannot think of sufficient adjectives to make the attempt. To Cheryl and John, my wonderful in-laws, your encouragement and moral support has been incredibly important to me, as was your cruise companionship and puppy spoiling. To my sisters and brothers and their spouses, Kevin & Beth, Amy & Hugh, Michael & Jen, Ben & Alysia, you have supported me without bounds, with encouragement, and with patience. I love you and could not ask for more! To the rest of my friends and family, I am forever grateful for your support, humor, camaraderie, and tolerance while I disappeared for school; you know who you are and know how much I love you! To my beloved Grandpa Mendy, who called me ‘doctor’ since middle school, I know you would have been enormously proud. I incessantly bored you with details of school and my dissertation, and every word was declared brilliant. How much more wind in my sails could I have asked for? I must thank my work family, especially my awesome boss Heidi, and my amazing team, most notably Danielle & Dean; you put up with my lunacy, wacky leadership, and work addiction, with great tolerance, partnership, and friendship. I would never have been able to finish this program if I did not have your support. To my Broward Fierce Fighters dragon boat teammates and coach, who helped me exercise my body when I was not exercising my mind; you were fast friends and comrades who I cannot imagine living without. Last, but definitely not least, a tremendous thank you to my dream team dissertation committee, consisting of my chair, Dr. Rhoades, and committee members Dr. Mohr and Dr. Kroposki; you were so patient and understanding! I do not know if I deserved you, but I am beyond grateful you took a chance on me!
Acknowledgements: 
I would like to acknowledge my chair, Dr. Jeffrey Rhoades, who provided exceptional guidance and imparted practical wisdom in my dissertation journey. The day Dr. Rhoades accepted my chair request I ran around my house screaming, “I got my #1!” to a very confused daughter, husband, and dog. It was the first of many lucky breaks on my dissertation. Following that windfall, I had the good fortune of adding Dr. David Mohr and Dr. Margaret Kroposki to my committee. And with that, my committee dream team was forged! I underestimated the learning I would realize under their direction and the wisdom I would absorb from their feedback. I will never take their support for granted and know I am better and more confident because of it. I would also like to thank and acknowledge the University of Phoenix who provided a scholarship for my doctorate program. It was incredibly humbling to win such a generous scholarship, for which I am forever grateful. I look forward to proving the investment by my committee and the University was worthwhile and will result in enduring dividends.