Only 23% of Those With Prediabetes Are Treated

Missed opportunities exist for diabetes prevention in primary care, according to a new study.

“Even though detection and treatment of prediabetes is a critical and recommended strategy in diabetes prevention, the very low frequency in which detection and treatment happens is disappointing,” said lead study author Arch G. Mainous III, PhD, from department of health services research, management, and policy at the University of Florida. “The findings were more concerning because we know that the physicians had access to a current blood glucose measure on the patients, which fell into the range for prediabetes.”
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Using data from the 2012 National Ambulatory Medical Care Survey, the researchers studied visits by adults aged >45 years without diagnosed diabetes who had an HbA1c test within 90 days of the visit (n=518 unweighted visits; n=1167004 weighted visits). They categorized HbA1c results into normal, prediabetes, and diabetes and examined patient characteristics (age, sex, race, payer type, BMI) and treatment of prediabetes.

Among visiting adults, 54.6% had a normal HbA1c value, 33.6% had prediabetes, and 11.9% had diabetes. Of those patient visits with HbA1c consistent with prediabetes, the number of people diagnosed with prediabetes was too low for a reliable population estimate. Indication of treatment in the medical record (lifestyle modification counseling and/or metformin) was present in 23.0% of those with diagnosed or undiagnosed prediabetes. Lifestyle modification counseling led the way as the most common treatment.

“The biggest food for thought for primary care providers is there is room for improvement in practice,” Mainous said. “The US Preventive Services Task Force and the American Diabetes Association recommend screening for prediabetes and treating if it is found. Because of the huge amount of resources the US society spends on diabetes management, focusing on improving practice around diabetes prevention seems worthwhile.”

He’s currently undertaking a survey of several thousand academic family physicians to try and understand the key factors that play into the low rate of detection and treatment.

“We do not know if it is knowledge deficits, systems issues, or access to services, but this survey will help to pin that down,” Mainous said. “We will use that data to devise a trial to see if we can improve care for diabetes prevention.”

-Mike Bederka

Reference:

Mainous AG 3rd, Tanner RJ, Baker R. Prediabetes diagnosis and treatment in primary care. J Am Board Fam Med. 2016 Mar-Apr;29(2):283-5. doi:10.3122/jabfm.2016.02.150252.