Only 6% of primary care physicians (PCPs) surveyed could successfully identify all prediabetes risk factors as outlined by the American Diabetes Association (ADA), according to a recent survey from Johns Hopkins researchers published in the Journal of General Internal Medicine.
According to Centers for Disease Control and Prevention (CDC) estimates, 86 million adults in the United States have prediabetes, 90% of whom have no knowledge of their condition, and 70% of whom will eventually develop type 2 diabetes.
“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,” said lead author Eva Tseng, MD, MPH, assistant professor, Johns Hopkins University School of Medicine, Baltimore, MD.
To better understand this, Dr. Tseng and colleagues created a survey to test awareness of expert prediabetes guidelines and beliefs about the management of prediabetes.
During an annual retreat and medical update for PCPs in the Mid-Atlantic region, Dr. Tseng and fellow researchers distributed an on-site survey to the 156 participants. They believe this survey to be one of the first to formally test PCP knowledge of current professional guidelines for such screening.
In the survey, PCPs were asked to do the following:
- Select prediabetes risk factors from a list of factors recommended by ADA guidelines for prediabetes screening,
- Identify numerical values corresponding to upper and lower limits of fasting glucose and HbA1c lab criteria for diagnosing prediabetes,
- Identify ADA recommendations for minimum weight loss and minimum physical activity for prediabetic patients,
- Identify the best initial management approach for patients with prediabetes,
- Detail which prediabetes screening tests they used,
- Detail their initial patient management approaches, and
- Identify the proper intervals for repeat lab work and follow-up visits.
Responders were also asked to rate, on a 5-point scale, whether they believe it is important to identify prediabetes and whether they believe lifestyle modifications and metformin therapy could reduce the risk of progression to diabetes. Researchers also used a similar scale to assess provider perceptions on patient barriers to lifestyle modification and metformin use.
One-hundred forty PCPs responded, of whom only 6% could identify all risk factors that should prompt prediabetes screening. Furthermore, only 17% could correctly identify the fasting glucose and HbA1c laboratory values for a diagnosis of prediabetes. On average, these respondents chose 8 of 11 correct risk factors for prediabetes screening.
Elevated fasting glucose levels of 100 to 125 mg/dL or an HbA1c of 5.7% to 6.4% are indicative of a diagnosis of prediabetes. Fasting glucose levels ≥ 126 mg/dL or HbA1c of ≥ 6.5% are indicative of diabetes.
As the recommended initial management approach to prediabetes, only 11% of PCPs selected referral to a behavioral weight loss program—the initial approach recommended by the ADA, while 96% selected diet and physical activity counseling.
Results also showed that metformin use for prediabetes was not common, with 25% of PCPs reporting that they never prescribed metformin for prediabetes, and 16% reporting that they did not believe in prescribing metformin for prediabetes.
According to the ADA’s 2017 guidelines, metformin should be considered as therapy in patients with prediabetes who fail to decrease their risk of diabetes through lifestyle changes.
Finally, researchers found that nearly one-third of PCPs were not familiar with the ADA’s guidelines for prediabetes.
“Primary care providers play a vital role in screening and identifying patients at risk for developing diabetes. This study highlights the importance of increasing provider knowledge and availability of resources to help patients reduce their risk of diabetes,” concluded senior author Nisa Maruthur, MD, MHS, assistant professor of medicine, Johns Hopkins University School of Medicine.
Dr. Tseng is supported by training grant T32HL007180-41. This study received analytic support from the Baltimore Diabetes Research Center (National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease, grant P30 DK079637).