<p> <i>Purpose:</i> Implement and evaluate a formal evidence-based risk screening protocol in a rural clinic setting to optimize early identification of prediabetes and T2DM in asymptomatic, non-pregnant adults age 18&ndash;44. </p><p> <i>Significance:</i> Absence of an evidence-based risk screening protocol contributed to under/overutilization in laboratory test referral and inconsistency in prescribed treatments among clinic providers. Early identification of prediabetes and initiation of appropriate treatment plans may assist in preventing T2DM and its associated complications. </p><p> <i>Methodology:</i> Quality improvement project utilizing a retrospective, randomized representative sample of charts, <i>n</i> = 30 and a convenience sample of participants, <i>n</i> = 40. The American Diabetes Association Diabetes Risk Test (ADA DRT) served as a prediabetes risk screening tool. Provider adherence to ADA DRT risk screening and laboratory test referral, type of laboratory test ordered, the relationship between demographic characteristics and the ADA DRT score, participant follow-up, and treatment ordered based on risk screening and laboratory results were analyzed using group data. </p><p> <i>Results:</i> Thirteen (35.7%) participants had laboratory values in the prediabetes or T2DM range and 100% of treatment ordered are substantiated by ADA guidelines. Using the ADA DRT tool, risk screening was completed in 100% of eligible participants; accordingly, appropriate utilization of laboratory test referral improved by 33.33%. </p><p> <i>Recommendation:</i> Incorporation of best-practices for risk screening and laboratory test referral for early identification of prediabetes is needed. APRNs are instrumental in promoting efficacious screening strategies and preventative treatment aimed at improving health outcomes. The benefits of using the ADA DRT as a prediabetes risk screening protocol in primary care should be elucidated in a prospective study.</p><p>