# Prevent Diabetes Mellitus (PreDM) Clinical Decision Support Intervention in Community Health Centers

> **NIH AHRQ R18** · NORTHWESTERN UNIVERSITY · 2020 · $382,928

## Abstract

Project Summary
 Eighty six million U.S. adults have prediabetes, and up to 75% of them will eventually develop diabetes.
Landmark clinical trials have established that intensive lifestyle interventions (ILI) and metformin are safe and
effective treatments to prevent or delay diabetes in adults with prediabetes and overweight/obesity. Despite
being included in expert clinical guidelines, these treatments are rarely used and few studies have explored how
to promote their uptake in practice. One possible approach for increasing adoption of ILI and metformin in primary
care includes clinical decision support (CDS), which uses electronic systems to create tailored recommendations
for evidence-based clinical care. While a large body of evidence demonstrates that CDS can improve the delivery
of other recommended preventive services, this approach has not been definitively studied for ILI and metformin.
We plan to address this critical knowledge gap by developing and evaluating the Prevent Diabetes Mellitus
Clinical Decision Support (PreDM CDS) intervention for community health center patients with prediabetes and
overweight/obesity. This novel CDS engages primary care providers and clinical staff to deliver the following
intervention components: 1) a decision aid about diabetes prevention developed by our team; 2) an EHR referral
to community-based ILI that meet recommended program requirements; and 3) a prompt for providers to
consider prescribing metformin. Clinicians will receive monthly feedback about their use of the PreDM CDS
through an existing dashboard. By accomplishing the following specific aims, this definitive R18 study will test
the potential for CDS to promote diabetes prevention and weight loss efforts in primary care. In Aim 1, we will
develop the proposed intervention by translating narrative guidelines about ILI and metformin into CDS, while
incorporating extensive feedback from users. Aim 2 is a pragmatic cluster randomized trial, including 6 large
community health center sites, which will examine the effectiveness of the PreDM CDS at inducing weight loss
and improving other cardiometabolic markers. Aim 3 is a mixed-methods evaluation of the PreDM CDS, exploring
its reach, adoption, implementation, maintenance, and cost. We hypothesize that the proposed PreDM CDS will
increase patient's adoption of ILI and metformin, producing weight loss and improvements in other
cardiometabolic markers. The resulting data, and an implementation toolkit created by the study team, will
support the widespread dissemination of the PreDM CDS if found to be effective in the proposed study. Our
proposal is responsive to PA-17-261 by: 1) developing new CDS that incorporates evidence-based guidelines
for diabetes prevention that are infrequently used in current clinical practice; 2) evaluating the impact of the
proposed CDS on patient outcomes, clinical workflows, healthcare process measures, adherence to guidelines,
and costs; and 3) conducting this R18 s...

## Key facts

- **NIH application ID:** 9957044
- **Project number:** 5R18HS026172-03
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Matthew James O'Brien
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $382,928
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9957044

## Citation

> US National Institutes of Health, RePORTER application 9957044, Prevent Diabetes Mellitus (PreDM) Clinical Decision Support Intervention in Community Health Centers (5R18HS026172-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9957044. Licensed CC0.

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