Survey of primary care providers’ knowledge of screening for, diagnosing and managing prediabetes
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Prediabetes affects 86 million US adults, but primary care providers’ (PCPs') knowledge, practices, attitudes and beliefs toward prediabetes are unclear.
Assess PCPs’ (1) knowledge of risk factors that should prompt prediabetes screening, laboratory criteria for diagnosing prediabetes and guidelines for management of prediabetes; (2) management practices around prediabetes; (3) attitudes and beliefs about prediabetes.
Self-administered written survey of PCPs.
One hundred forty of 155 PCPs (90%) attending an annual provider retreat for academically affiliated multispecialty practices in the mid-Atlantic region.
Descriptive analyses of survey questions on knowledge, management, and attitudes and beliefs related to prediabetes. Multivariate logistic regression was used to determine the association between provider characteristics (gender, race/ethnicity, years since training, specialty and provider type) and knowledge, management, and attitudes and beliefs about prediabetes.
Six percent of PCPs correctly identified all of the risk factors that should prompt prediabetes screening. Only 17% of PCPs correctly identified the laboratory parameters for diagnosing prediabetes based on both fasting glucose and hemoglobin A1c. Nearly 90% of PCPs reported close follow-up (within 6 months) of patients with prediabetes. Few PCPs (11%) selected referral to a behavioral weight loss program as the recommended initial management approach to prediabetes. PCPs agreed that patient-related factors are important barriers to lifestyle change and metformin use. Provider characteristics were generally not associated with knowledge, management, attitudes and beliefs about prediabetes in multivariate analyses.
Addressing gaps in knowledge and the underutilization of behavioral weight loss programs in prediabetes are two essential areas where PCPs could take a lead in curbing the diabetes epidemic.
KeywordsPrediabetes Prevention Primary care
Compliance with ethical standards
Dr. Eva Tseng is supported by training grant T32HL007180–41. Dr. Raquel Greer is supported by National Institutes of Health grant K23DK094975. This study received analytic support from the Baltimore Diabetes Research Center (National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Disease, grant no. P30 DK079637).
This work was presented at the Society of General Internal Medicine Annual Meeting in May 2016.
Conflict of interest
The authors declare that they do not have a conflict of interest.
- 1.Prevent Diabetes STAT. Prevent Diabetes STAT Web site. http://www.ama-assn.org/sub/prevent-diabetes-stat/index.html. Updated 2015. Accessed 23 May 2017.
- 2.Centers for Disease Control and Prevention (CDC). Awareness of prediabetes—United States, 2005-2010. MMWR Morb Mortal Wkly Rep. 2013;62(11):209–212.Google Scholar
- 9.Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The diabetes prevention program outcomes study. Lancet Diabetes Endocrinol. 2015.Google Scholar
- 10.American Diabetes Association. Prevention or delay of type 2 diabetes. Diabetes Care. 2017;40(Supplement 1):S44–S47.Google Scholar
- 11.Centers for Disease Control and Prevention (CDC). National Diabetes Prevention Program. National Diabetes Prevention Program Web site. http://www.cdc.gov/diabetes/prevention/index.htm. Updated 2016. Accessed 23 May 2017.
- 14.Schmittdiel JA, Adams SR, Segal J, Griffin MR, Roumie CL, Ohnsorg K, et al. Novel use and utility of integrated electronic health records to assess rates of prediabetes recognition and treatment: Brief report from an integrated electronic health records pilot study. Diabetes Care. 2014;37(2):565–568.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Chan WV, Pearson TA, Bennett GC, Cushman WC, Gaziano TA, Gorman PN, et al. ACC/AHA Special Report: Clinical practice Guideline Implementation Science Work Group: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69(8):1076–1092.CrossRefPubMedGoogle Scholar
- 22.Kane RL, Johnson PE, Town RJ, et al. Economic Incentives for Preventive Care: Summary. In: AHRQ Evidence Report Summaries. Rockville (MD): Agency for Healthcare Research and Quality (US); 2004: 1998–2005. 101. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11845/
- 24.Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, et al. The Finnish Diabetes Prevention Study (DPS). Diabetes Care. 2003;26(12):3230–3236.Google Scholar
- 25.Spitalnic P. Certification of Diabetes Prevention Programs [Internet]. Baltimore (MD): Department of Health and Human Services; 2016 [cited 2016 Sept 9]. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf
- 26.Tseng E, Yeh HC, Maruthur NM. Metformin use in prediabetes among US adults, 2005-2012. Diabetes Care. 2017. doi: 10.2337/dc16-1509.
- 27.Mainous AG, Tanner RJ, Scuderi CB, Porter M, Carek PJ. Prediabetes screening and treatment in diabetes prevention: the impact of physician attitudes. J Am Board Fam Med. 2016;29(6):663–671.Google Scholar