Findings from a recent survey of over 140 primary care providers (PCPs) suggest that few of them know when to screen patients for prediabetes.

In a recent study conducted by Eva Tseng, MD, from Johns Hopkins University, found that only 6% of the 140 PCPs surveyed, correctly identified 11 risk factors for prediabetes that should prompt further screening per the guidelines of the American Diabetes Association (ADA). Other questions related to laboratory values, dietary and exercise guidelines.

Most participants of the survey were physicians trained in internal medicine, family medicine, or internal medicine-pediatrics. There were nine nurse practitioners and one physician assistant. Almost 75% were female, 55% were white, 23% Asian, and 14% African American. More than half (59%) had been in practice at least 10 years.

The 11 risk factors for prediabetes they were asked to identify were:

Age ≥ 45 years


BMI ≥ 25 kg/m2


Hypertension


Dyslipidemia


Heart disease


Family history of diabetes in first degree relative


Sedentary lifestyle


African- American race


Asian- American race


History of gestational diabetes


Latino ethnicity


Relevant results showed:

  • On average, the PCPs were able to identify 8 of 11 risk factors
  • Asian race and Latino or Hispanic ethnicity was the one most commonly missed
  • Only 17% correctly identified levels for fasting glucose (100-125mg/dL ) and HbA1c (5.7%-6.4%) in these patients
    • Of the medicine-pediatrics providers, 43% picked correct HbA1c values vs 20% of family medicine and 12% of internal medicine specialists (which was statistically significant  (P = .02))
  • Almost all (99%) identified counseling on diet and physical activity as their initial management strategy, with 12% referring patients to behavioral weight loss programs
  • Although 42% of the respondents found the ADA guidelines helpful, 30% were unfamiliar with them

Prediabetes affects more than 86 million American adults—nearly 1 out of every 3—and more than 70% of them will go on to develop diabetes. Diet and lifestyle changes could prevent this progression, but nearly 90% of those with the condition are not aware they have it. Furthermore, as Tseng notes, only a 25% of patients report receiving relevant nutrition and lifestyle change recommendations.

Why is this Clinically Relevant?

PCPs are critical in screening and identifying patients with prediabetes and these results underscore the need to increase provider knowledge to help them optimize patient outcomes in this population and reduce risk for progression to T2D

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