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Research Project by Medical Students Looks at Improving Prediabetes and Diabetes in Primary Health Care

Date Posted: Thursday, July 30, 2020


Prediabetes is a health condition characterized by higher than normal blood sugar levels, but not yet high enough to be diagnosed as diabetes.  Prediabetes affects over one third of Massachusetts residents (35%), and according to the American Diabetes Association (ADA), more than 90 million adults nationwide.

It’s regarded as an indicator that a person is at risk of developing Type 2 diabetes (T2D), along with the potential health complications that comes with it.  For some people diagnosed with prediabetes, a lifestyle change of proper nutrition and physical activity can lower blood sugar levels back into a healthy normal range.

The ADA recommends people with prediabetes participate in a Diabetes Prevention Program (DPP) recognized by the Centers for Disease Control (CDC).  These programs offer scientifically proven and effective lifestyle changes that can prevent or delay type 2 diabetes.

Prior to completing their studies at UMass Chan Medical School, Dr. Ashley Millette Cote and Dr. Alexandria Capozza completed a capstone research project that analyzed the effectiveness of DPP in Massachusetts.  They also developed an elective class at the medical school to teach nursing and medical school students about the best available care for people living with prediabetes and T2D.

Ashley Millette Cote, MD                  Alexandria Capozza, MD

For the first part of their project, they surveyed participants in Diabetes Prevention Programs at YMCA’s from Worcester to the greater Boston area, who had been diagnosed with prediabetes.  They were interested in what the participants learned about diabetes from their primary care physicians (PCP) compared to the knowledge they acquired in the DPP classes, then identifying where the gaps were.  The data they collected indicates DPP classes are highly effective community resources for people with prediabetes, providing people with a better understanding about the importance of nutrition, exercise, and weight loss.

“100% of those we surveyed reported weight reduction,” said Dr. Millette Cote.  “The average weight loss of the participants in our study was 13 pounds.”

Survey responses also suggested only a small number of primary care physicians are educating and counseling patients about prediabetes and its negative health effects. “A majority of patients found out about the YMCA DPP classes on their own, and were not referred by their PCP,” according to Dr. Millette Cote.  “We discovered that not all PCPs consider prediabetes something that need to be treated, and many don’t realize community resources such as DPP are available.”  One of the takeaways from the project was the need to provide information to PCP offices about community resources that exist for people living with diabetes.  

“These DPP classes are definitely a time and money commitment for people to make, but it could help those who would benefit from a structured program to improve their health,” added Dr. Millette Cote.    

The second part of their project was to provide an elective class for UMass Chan Medical School medical and nursing students, teaching them how to provide adequate care to people with prediabetes and T2D.  Topics included medication management, glucose monitoring, nutrition and lifestyle modification, with a goal of reducing the risk of developing diabetes and the long-term health complications associated with T2D.  Students were surveyed both before and after taking the class about their knowledge of prediabetes and diabetes prevention methods.  The data from the project suggests the curriculum provided an effective way to improve knowledge about prediabetes care, risk factors for developing T2D, counseling patients on living a healthy lifestyle, and how to care for gestational diabetes

“It was rewarding that 100% of students felt comfortable counseling patients on ways to reduce diabetes risk by the end of the elective course, compared to just over 26% at the start of the elective,” said Dr. Capozza.

Dr. Alexandria Capozza is currently practicing Internal Medicine at UMass Memorial Medical Center.

Dr. Ashley Millette Cote is currently practicing Family Medicine in Tacoma, Washington.

Learn about the diabetes care provided at the UMass Memorial Diabetes Center of Excellence.

More Diabetes Center of Excellence News