Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of interventions for preventing or delaying progression to diabetes?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Behavioral:

• Counseling: group vs individual
• Nutritional interventions: group vs individual
• Physical activity
• Weight loss interventions and counseling

Pharmacologic:

• Specific medications (metformin vs weight loss drugs)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

• Obese individuals, prediabetic, impaired glucose tolerance
• Women
• Adolescents
• Children
• High risk groups including minorities

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

• Pregnant women
• Hispanic individuals
• African Americans

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Diabetes prevention
• Prevention of diabetes-related complications (e.g. micro and macrovascular disease)
• Prevention of chronic disease

Describe any health-related risks, side effects, or harms that you are concerned about.

• Medication harms and side effects
• Social stigmatization

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Diabetes mellitus
• Obesity
• Pregnancy, including preterm birth

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

The lifetime risk of type 2 diabetes is high, yet our ability to predict and prevent type 2 diabetes in the general population is limited. Subjects at high-risk are appropriate candidates for preventive interventions and include those with impaired fasting glucose, impaired glucose tolerance, obesity, close relatives with type 2 diabetes, or who are members of certain ethnic groups (Asian, Hispanic, black). These individuals are at higher risk of developing type 2 diabetes and the subsequent health problems associated. Three factors have been evaluated in an attempt to prevent type 2 diabetes: exercise, weight loss, and drug therapy. In various studies, each of these methods has been evaluated, but currently, no single agent is definitively recommended for diabetes prevention. A review of the evidence would inform health policy and provide practical guidance to clinicians.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Three factors have been evaluated in an attempt to prevent type 2 diabetes (diet, exercise, drug therapy) but the most effective method is unclear.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

This report will help identify effective approaches for preventing progression to Type 2 Diabetes Mellitus.

Describe the timeframe in which an answer to your question is needed.

Not aware of a specific timing issue

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Women, adolescents, children, high risk groups including minorities, and pregnant women

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

This report will help identify effective approaches for preventing progression to Type 2 Diabetes Mellitus.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program