Many PC Docs Can’t ID Prediabetes Risks

The small survey of primary care physicians also found that nearly one-third of them were unfamiliar with the American Diabetes Association’s guidelines for prediabetes.

Nearly 90 million people have prediabetes in the United States, but the “vast majority” of 140 primary care physicians who were asked to identify the 11 risk factors for the condition could not do so, a new study shows.

The small survey was conducted by Johns Hopkins researchers during a retreat and medical update for primary care physicians. The findings, which are believed to be the first to formally test primary care physicians’ knowledge of guidelines for prediabetes screenings, were published this week in the Journal of General Internal Medicine.

“Although this survey was conducted among primary care providers from a large academically-affiliated practice and may not represent providers from other types of practice settings, we think the findings are a wake-up call for all primary care providers to better recognize the risk factors for prediabetes, which is a major public health issue,” Eva Tseng, MD, the study’s first author and an assistant professor at the Johns Hopkins University School of Medicine, said in accompanying remarks.

Of the providers who completed the survey, only 6% correctly identified all of the risk factors that the American Diabetes Association said should prompt prediabetes screening. Seventeen percent identified the fasting glucose and HbA1c, laboratory values for diagnosing prediabetes. On average, the physicians picked eight out of the 11 risk factors for prediabetes screening.

The survey also found that nearly one-third of the primary care physicians were unfamiliar with the American Diabetes Association’s guidelines for prediabetes.

An estimated 86 million adults in the United States have prediabetes; 70% of these individuals will eventually develop type 2 diabetes, according to the Centers for Disease Control and Prevention and ADA expert panel. Preventive measures such as changes in diet and physical activity and the prescription of metformin, an oral diabetes medication that helps control blood sugar levels, have proven effective in preventing the progression of prediabetes to type 2 diabetes, the ADA said.

An estimated 90% of people with prediabetes are unaware of their condition, according to the CDC. To better understand why so many with prediabetes go undiagnosed, the Johns Hopkins researchers created the survey to test awareness of expert prediabetes guidelines and beliefs regarding prediabetes management.

At an annual retreat and medical update held for Mid-Atlantic region primary care physicians in 2015, the researchers invited all 156 primary care physicians who attended the meeting to participate in the on-site survey, and asked them to select prediabetes risk factors from a list of factors recommended by the ADA guidelines for the screening of prediabetes.

The survey also asked the physicians to identify guidelines issued by the ADA about prediabetes screening; numerical values corresponding to the upper and lower limits of the fasting glucose and HbA1c laboratory criteria for diagnosing prediabetes; values corresponding to the ADA’s recommendations for minimum weight loss and minimum physical activity for patients with prediabetes; best initial management approach to a patient with prediabetes; prediabetes screening tests used; initial patient management approaches; and intervals used for repeat lab work and follow-up visits.

To evaluate attitudes and beliefs regarding prediabetes, the survey asked providers to rate, on a five-point scale whether they believe it is important to identify prediabetes and whether they believe that lifestyle modification and metformin can reduce the risk of progression to diabetes. A similar scale was used to evaluate what providers perceive as patient barriers to lifestyle modification and the use of metformin.

While only 11% of physicians selected referral to a behavioral weight loss program as the recommended initial management approach to prediabetes, 96% selected counseling on diet and physical activity. Behavioral weight loss programs are the recommended initial approach by the ADA. The survey also revealed that metformin use for prediabetes was uncommon: 25% of providers never prescribed metformin and 16% did not believe in prescribing metformin for patients with prediabetes. In the 2017 guidelines, the ADA is now recommending that metformin be considered in patients with prediabetes who have failed to decrease their risk of diabetes through lifestyle change.