PCPs are Missing Prediabetes, Survey Finds

The CDC's Diabetes Prevention Program (click to enlarge)

In a survey of US primary care physicians (PCPs), less than half (42%) of respondents chose the correct values of key laboratory tests that would identify prediabetes. Only 8% knew that a 7% weight loss is the minimum recommended by the American Diabetes Association as part of a lifestyle-change approach to prevent progression to type 2 diabetes mellitus (T2DM). A number of other significant gaps in knowledge and practice were also uncovered.

The survey of 1000 US PCPs was conducted by researchers at Johns Hopkins Medicine (JHM) and the results published online September 9 in the Journal of General Internal Medicine. The survey assessed PCP knowledge, practice behaviors, and perceptions related to prediabetes and is believed to be the first national survey to evaluate PCP knowledge and practices related to the precursor to T2DM. 

"Our survey findings suggest that these gaps contribute to doctors underscreening for and missing diagnoses of prediabetes," Eva Tseng, MD, MPH, assistant professor of general internal medicine at the Johns Hopkins University School of Medicine and lead study author said in a JHM press release. When the diagnosis is not made, Dr Tseng continued, patients are not referred to diabetes prevention programs.

Moreover, according to Johns Hopkins associate professor of medicine and a co-author of the JGIM paper Nisa Maruthur, MD, MHS “Our results also suggest that 25% of PCPs may be identifying people as having prediabetes when they actually have diabetes, which could lead to delays in getting those patients proper diabetes care and management."

Given the rapid pace of US efforts to prevent T2DM, the authors stress that understanding how prediabetes is managed in primary care is critical.

In total, 298 (33%) eligible participants returned the survey.

Next: Key study findings

Among the key findings reported in the study: • PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes.

• One-fourth of PCPs reported using a non-fasting glucose for prediabetes screening even though no such diagnostic criteria exist.

• Only 36% of PCPs refer patients to a diabetes prevention lifestyle change program as their initial management approach while 43% discuss starting metformin for prediabetes.

• PCPs believed that barriers to type 2 diabetes prevention exist at both the individual level (eg, patients’ lack of motivation) and at the system level (eg, lack of weight loss resources).

• PCPs reported that increased access to and insurance coverage of T2DM prevention programs and coordination of referral of patients to these resources would facilitate preventive efforts.

According to the CDC, ~84 million Americans ages 18 or older, or more than 1 of 3 adults, have prediabetes but 90% don't know it.

The authors conclude in part by noting that providers may be have difficulty staying current with evidence for prediabetes given competing demands, eg, the need to meet quality metrics and maintain patient volume. They suggest that systematic education efforts for PCPs be augmented by expanding roles for other care team members and providing clinical decision support--both ways to improve prediabetes identification and management.

Finally they state: “PCPs play a critical role in identifying and treating the one in three adults with prediabetes. As type 2 diabetes prevention grows through dissemination of evidence-based interventions, increased engagement of PCPs is the next step to addressing the diabetes epidemic.”

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