Prediabetes Among Adults 45-64 in a Rural County Service Area: A Population Profile and a Matched Referral Intervention
[Author Name]
College of Nursing, Herzing University
NU 780 Population Health
Unit 3 Assignment
[Instructor Name]
August 11, 2026
Original model document written by our desk. The county, the clinic sites and every local count in it are a composite; no real community, organization or patient is described.
The Population and Its Data Sources
The population is adults aged 45 to 64 who live in a rural county service area of 61,400 residents and who had at least one primary care visit at either of the two community health center sites in the county during the 12 months ending December 31, 2025. County residents in that age band number 16,240. Of those, 9,860 had a qualifying visit in the window, so the paper describes 60.7 percent of the age band rather than the whole of it, and every rate below is anchored to the 9,860 unless a different denominator is named. The age band was chosen because it carries the county's highest burden of undetected metabolic risk and because it sits inside the eligible range for screening.
Three data sources were used and each has a stated limit. Counts of visits, recorded body mass index, laboratory results and referrals were drawn from the shared electronic record of the two sites, which covers care delivered at those sites and misses care delivered at the regional hospital 38 miles away. Population denominators came from census estimates for the county, which are estimates rather than a count. National comparison figures came from the Centers for Disease Control and Prevention national diabetes statistics report, which reports prevalence for all adults and not for a rural subset, so the comparison shows direction rather than an exact gap. Where the three sources disagree, the electronic record is used for numerators and the census estimate for denominators.
Context matters to what can be recommended later, so it is stated here rather than in the plan. The county has no public transport route between its two population centers, and the nearest in-person lifestyle change program recognized by the Centers for Disease Control and Prevention meets in a city 38 miles from the larger of the two sites. Among the 9,860 adults described here, 2,109 were recorded as uninsured at their most recent visit, or 21.4 per 100. Two grocery stores serve the county and one closed during the window. None of these facts changes the prevalence figures in the next section, but each one constrains which intervention can be delivered at all.
What the Data Show
The first finding is a screening gap. Of the 9,860 adults aged 45 to 64 seen in the 12-month window, 4,905 had a hemoglobin A1C or a fasting glucose recorded, a screening rate of 49.7 per 100 patients seen. The U.S. Preventive Services Task Force (USPSTF) recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who have overweight or obesity, and 7,318 of the 9,860 had a recorded body mass index of 25 or higher, so roughly three quarters of this group met the eligibility criterion. Measured against that eligible denominator rather than against all patients seen, screening coverage falls to 4,181 of 7,318, or 57.1 per 100 eligible adults. Two in five eligible adults left the year untested.
The second finding is what the tests returned. Among the 4,905 adults tested in the window, 1,412 had a hemoglobin A1C between 5.7 and 6.4 percent, a 12-month prediabetes prevalence of 28.8 per 100 adults tested, and a further 388 had a result at or above 6.5 percent that meets the threshold for diabetes. The national estimate reported by the Centers for Disease Control and Prevention places prediabetes near 38 per 100 adults, which sits above the figure measured here. The gap is unlikely to mean this county is healthier than the country. It is more likely that the untested half of the eligible group contains cases, because the adults least likely to be tested are those who attend least often.
The third finding decides the intervention. Of the 1,412 adults with a result in the prediabetes range, 63 were referred to a recognized lifestyle change program during the same 12 months, a referral rate of 4.5 per 100 adults who had the result in hand. Twenty-one of the 63 enrolled and nine attended at least 16 sessions. Read as a chain, the numbers fall away at each link: 7,318 eligible, 4,905 tested, 1,412 with a result in the prediabetes range, 63 referred, 21 enrolled, 9 with a dose of the program large enough to matter. The largest single loss is not detection and not attendance. It is the step between a result on a screen and a referral placed.
The Matched Intervention and Its Measures
An intervention matched to these data does not begin with education about diabetes, because the population already reaches care and the results already exist. It begins at the two links where the chain breaks. First, a standing screening order added to check-in for every patient aged 35 to 70 with a recorded body mass index of 25 or higher and no A1C in the past 36 months, so the test is ordered by protocol rather than by memory. Second, a closed-loop referral built into the visit at which an abnormal result is reviewed: the referral is placed before the patient leaves, the program contacts the patient within five business days, and the record is updated with enrolled, declined or unreachable rather than left open.
The program at the end of the referral is the National Diabetes Prevention Program lifestyle change curriculum, which is the intervention the trial evidence supports. The Diabetes Prevention Program trial reported a 58 percent lower incidence of type 2 diabetes with the lifestyle arm against placebo over an average of just under three years, and the ten-year follow-up study reported a 34 percent lower incidence, so the effect is large and it persists at a reduced size. Because the county has no local in-person program and no public transport, delivery is contracted as distance sessions with a recognized provider, with at least 16 core sessions in the first six months and monthly sessions after that. Attendance targets follow the recognition standard rather than a local guess.
Three measures track the two links and one measures the outcome. Screening coverage is reported quarterly as tested adults per 100 eligible adults seen, with a first-year target of 75 from a baseline of 57.1. Referral is reported as referrals placed per 100 adults with a result in the prediabetes range, with a first-year target of 40 from a baseline of 4.5. Enrollment is reported as adults attending at least 16 core sessions per 100 referred. The outcome measure is the proportion of participants with a repeat A1C below 5.7 percent at 12 months. Each measure is reported with insurance status attached, because a plan that lifts the county average while leaving the 2,109 uninsured adults where they were has not worked.
References
Centers for Disease Control and Prevention. (2024). National diabetes statistics report. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/php/data-research/index.html
Centers for Disease Control and Prevention. (2024). National Diabetes Prevention Program. U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes-prevention/
Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6), 393-403.
Diabetes Prevention Program Research Group. (2009). 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. The Lancet, 374(9702), 1677-1686.
Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030: Diabetes. U.S. Department of Health and Human Services. https://health.gov/healthypeople
U.S. Preventive Services Task Force. (2021). Prediabetes and type 2 diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
How this NU 780 Unit 3 example is structured
In many sections this unit asks for a population profile with an intervention attached; your classroom's instructions and rubric decide the exact form, so read the assignment page before you use this NU 780 Unit 3 example as a shape. The order is the order a reviewer audits. The population and its data sources come first, so every later number has a denominator a reader can check and a window it was counted in. The findings come second, stated as rates rather than counts and set beside national figures so the reader can see whether this area is unusual. The intervention comes last, because it has to answer the specific failure the data expose rather than the general problem the subject suggests.
NU 780 Unit 3 questions, answered
What counts as a population in this kind of paper?
A population is a group you can put a denominator around. Adults 45 to 64 with a visit at two named sites in a stated 12 months is a population; the phrase rural adults is not, because nobody can count it. Pick the group your data can describe, then say plainly how much of the wider community that group leaves out.
Do I need real data for a population health paper?
Sections differ, so check the assignment page. Many ask you to use published figures from agency sources for the state or county and to build the local picture around them. If your setting numbers are illustrative, say so once in the paper, keep them internally consistent, and cite the agency data you did use for comparison.
How do I show my intervention is matched to the data?
Point at the number that made you choose it. If referrals fail, the plan fixes referrals; if detection fails, the plan fixes detection. Then set the target from the baseline you measured rather than from a round figure, and name the measure you will report. A reader should be able to trace the intervention back to one line in your findings.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Herzing University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.