Primary Care Providers Show Gaps in Prediabetes Risk Factors

HealthDay News — Most primary care physicians (PCPs) can’t identify all 11 risk factors for prediabetes, according to a study published online in the Journal of General Internal Medicine.

To investigate why so many patients with prediabetes go undiagnosed, Johns Hopkins researchers asked PCPs attending a medical retreat to complete a survey testing their knowledge of key risk factors for the condition. The American Diabetes Association (ADA) has guidelines that list a total of 11 specific risk factors that determine if a patient should be screened for prediabetes. They include physical inactivity, a first-degree relative with diabetes, hypertension, and a history of cardiovascular disease. A total of 140 PCPs took the survey. Nearly one-third of those surveyed weren’t even familiar with the ADA’s prediabetes guidelines, according to a Hopkins news release. Only 6% were able to identify all 11 risk factors. On average, the PCPs could correctly identify just 8 of the warning signs.

The PCPs also had to identify the healthy range for glucose test results used to diagnose prediabetes as well as recommendations about weight loss and physical activity for people with the condition. Only 17% identified the correct values for fasting glucose and HbA1c, the researchers found. Only 11% of the PCPs said they would refer a patient to a behavioral weight loss program, even though that’s what the ADA recommends. But 96% did choose to provide counseling on diet and physical activity, according to the news release. Most of the PCPs said they wouldn’t prescribe metformin for prediabetes. But in 2017, the ADA recommended that metformin be considered for patients with prediabetes who haven’t reduced their risk for diabetes through lifestyle changes alone.

“Addressing gaps in knowledge and the underutilization of behavioral weight loss programs in prediabetes are 2 essential areas where PCPs could take a lead in curbing the diabetes epidemic,” the authors write.

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Tseng E, Greer RC, O’Rourke P, et al. Survey of primary care providers’ knowledge of screening for, diagnosing and managing prediabetes [published online July 20, 2017]. J Gen Intern Med. doi:10.1007/s11606-017-4103-1