Preventing Diabetes: Impact of an EMR-Based Intervention for Enhanced Pre-Diabetes Management in Primary Care

NCT07252700 | Recruiting

• 1 other identifier: ECOS Ref No.: 2025-1224
• Study Type: interventional
• Target: 6,000
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study is to find out if adding electronic medical record (EMR) prompts helps prevent people with pre-diabetes from developing diabetes. It will also look at how these prompts affect doctor and patient behaviors. The main questions are: Does it improve follow-up care, such as blood tests, referrals, and medication? Does the EMR prompt reduce the number of patients who progress to diabetes within six months? Researchers will compare clinics that use EMR prompts with clinics that do not. Participants will: Receive usual care for pre-diabetes at their polyclinic In some clinics, doctors will see EMR prompts suggesting tests, referrals, and medication Complete surveys about their health and lifestyle at different time points

Conditions

Pre Diabetes; Diabetes (DM)

Keywords

prediabetes; primary care; electronic medical records (EMR); OurPractice Advisories

Outcome Measures

Primary Outcomes (1)

• Guideline-concordant prediabetes care

  The primary outcome of this study is the proportion of patients receiving guideline-concordant prediabetes care within 6 months of the index consultation, defined as the first prediabetes consultation during the study period at which patient meets eligibility criteria for prediabetes. 1. HbA1c test ordered and recorded in the EMR. 2. Referral to a dietitian or structured lifestyle programme placed and recorded in the EMR. 3. Follow-up visit ordered by the attending clinician. 4. Metformin prescription recorded in the EMR for eligible patients (HbA1c ≥ 6.5%). Scale: Guideline-concordant care is defined as a composite measure in which patients have at least two of the following four clinician-initiated care processes captured in EMR data: Method: EMR data extracted from the Epic system, including laboratory orders, referrals, visit scheduling, and medication prescriptions.

  From enrollment to the end of intervention period at 24 months. collected at baseline, 6 months, 12, months, 18 months and 24 months.

Secondary Outcomes (3)

• Progression to Diabetes

  Up to 24 months after index consultation

• Patient health activation

  Baseline, 6 months, and 12 months.

• Clinician perceptions and satisfaction with the EMR-based intervention

  Baseline, 6 months and 12 months

Study Arms (2)

EMR-Based Intervention - Practice advisories (OPA) in electronic medical records (EMR)

ACTIVE COMPARATOR

To implement a non-intrusive OPA in EMR (Epic) to appear in the OPA section of the Visit Navigator in Epic that will be triggered for patients with prediabetes to remind clinicians to fulfil the clinical workflow for managing patients with prediabetes

Behavioral: Electronic Medical Record-Based Clinical Decision Support

Comparison Group

NO INTERVENTION

Control clinics continue to use the clinical workflow without EMR-based OPAs, representing usual care.

Interventions

Electronic Medical Record-Based Clinical Decision Support BEHAVIORAL

A non-intrusive OurPractice Advisories (OPA) will be implemented in the Epic EMR system. The OPA will appear in the Visit Navigator and will be automatically triggered for patients with pre-diabetes. It will provide clinicians with reminders and decision-support options to complete the recommended clinical workflow for pre-diabetes management, including referrals, follow-up scheduling, HbA1c testing, and medication initiation when indicated.

EMR-Based Intervention - Practice advisories (OPA) in electronic medical records (EMR)

Eligibility Criteria

• Age: 21 Years - 59 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• All adults aged 21 to 59 years with prediabetes who attend any of the eight participating polyclinics during the study period will be included in the EMR-based analytic cohort.
• Prediabetes is defined as impaired fasting glucose or impaired glucose tolerance according to standard clinical criteria, with either diagnosis documented in the EMR problem list or visit diagnosis.
• Individuals with a prior diagnosis of diabetes will be excluded.
• Adults aged 40-59 years
• Diagnosed with prediabetes (impaired fasting glucose or impaired glucose tolerance)
• Receiving routine follow-up care at NUP polyclinics
• Able to provide written informed consent
• Able to complete questionnaires in English

You may not qualify if:

• Prior diagnosis of diabetes mellitus or gestational diabetes
• Severe acute or chronic liver or kidney disease
• Pregnancy
• Cognitive impairment
• Inability to communicate in English
• All clinicians that consult patients in National University Polyclinics

Sponsors & Collaborators

• Lynette Goh: lead
• National University Health System, Singapore: collaborator
• National University of Singapore: collaborator

Study Sites (1)

National University Polyclinics, Singapore

Singapore, 643664, Singapore

RECRUITING

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Related Links

• National population health survey 2024

MeSH Terms

Conditions

Glucose Intolerance; Diabetes Mellitus; Prediabetic State

Condition Hierarchy (Ancestors)

Hyperglycemia; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Central Study Contacts

Lynette ML Goh, BNutrDiet

CONTACT

6598235619; lynette_ml_goh@nuhs.edu.sg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Senior Principal Dietitian

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: November 28, 2025
• Study Start: September 2, 2025
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): March 31, 2028
• Last Updated: January 14, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

SG (1)