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National Survey of Primary Care Physicians’ Knowledge, Practices, and Perceptions of Prediabetes

  • Eva TsengEmail author
  • Raquel C. Greer
  • Paul O’Rourke
  • Hsin-Chieh Yeh
  • Maura M. McGuire
  • Ann L. Albright
  • Jill A. Marsteller
  • Jeanne M. Clark
  • Nisa M. Maruthur
Original Research

Abstract

Background

Despite strong evidence and national policy supporting type 2 diabetes prevention, little is known about type 2 diabetes prevention in the primary care setting.

Objective

Our objective was to assess primary care physicians’ knowledge and practice regarding perceived barriers and potential interventions to improving management of prediabetes.

Design

Cross-sectional mailed survey.

Participants

Nationally representative random sample of US primary care physicians (PCPs) identified from the American Medical Association Physician Masterfile.

Main Measures

We assessed PCP knowledge, practice behaviors, and perceptions related to prediabetes. We performed chi-square and Fisher’s exact tests to evaluate the association between PCP characteristics and the main survey outcomes.

Key Results

In total, 298 (33%) eligible participants returned the survey. PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes. 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 are both at the individual level (e.g., patients’ lack of motivation) and at the system level (e.g., lack of weight loss resources). PCPs reported that increased access to and insurance coverage of type 2 diabetes prevention programs and coordination of referral of patients to these resources would facilitate type 2 diabetes preventive efforts.

Conclusions

Addressing gaps in PCP knowledge may improve the identification and management of people with prediabetes, but system-level changes are necessary to support type 2 diabetes prevention in the primary care setting.

KEY WORDS

prevention survey research primary care 

Notes

Acknowledgments

The authors thank Mr. Paul Sharrett for his assistance with the survey mailings and data entry.

Funders

Johns Hopkins Primary Care Consortium Grant

Compliance with Ethical Standards

This study was exempted by the Johns Hopkins University School of Medicine Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

References

  1. 1.
    Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.Google Scholar
  2. 2.
    Tabak AG, Herder C, Rathmann W, Brunner EJ, Kivimaki M. Prediabetes: a high-risk state for diabetes development. Lancet 2012;379(9833):2279–90.CrossRefGoogle Scholar
  3. 3.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393–403.CrossRefGoogle Scholar
  4. 4.
    Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20(4):537–44.CrossRefGoogle Scholar
  5. 5.
    Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL. Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med 2015;163(6):437–51.CrossRefGoogle Scholar
  6. 6.
    Albright A. Diabetes Prevention and Management: The Thrill Is Not Gone. Diabetes Spectr 2014;27(1):63–8.CrossRefGoogle Scholar
  7. 7.
    Medicare Diabetes Prevention Program (MDPP) Expanded Model: Centers for Medicare & Medicaid Services; 2019 [cited 2019 April 23]. Available from: https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/.
  8. 8.
    Centers for Disease Control and Prevention. Diabetes Report Card 2010. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2012.Google Scholar
  9. 9.
    Centers for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2015.Google Scholar
  10. 10.
    Rhee MK, Herrick K, Ziemer DC, Vaccarino V, Weintraub WS, Narayan KM, et al. Many Americans have pre-diabetes and should be considered for metformin therapy. Diabetes Care 2010;33(1):49–54.CrossRefGoogle Scholar
  11. 11.
    Karve A, Hayward RA. Prevalence, diagnosis, and treatment of impaired fasting glucose and impaired glucose tolerance in nondiabetic U.S. adults. Diabetes Care 2010;33(11):2355–9.CrossRefGoogle Scholar
  12. 12.
    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):565–8.CrossRefGoogle Scholar
  13. 13.
    Moin T, Li J, Duru OK, Ettner S, Turk N, Keckhafer A, et al. Metformin Prescription for Insured Adults With Prediabetes From 2010 to 2012: A Retrospective Cohort Study. Ann Intern Med 2015;162(8):542–8.CrossRefGoogle Scholar
  14. 14.
    Tseng E, Greer RC, O’Rourke P, Yeh HC, McGuire MM, Clark JM, et al. Survey of primary care providers’ knowledge of screening for, diagnosing and managing prediabetes. J Gen Intern Med 2017;32(11):1172–1178.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    AMA Physician Masterfile: American Medical Association; 2018 [cited 2018 March 20]. Available from: https://www.ama-assn.org/life-career/ama-physician-masterfile.
  17. 17.
    American Diabetes Association. Prevention or Delay of Type 2 Diabetes. Diabetes Care 2017;40(Suppl 1):S44-S7.CrossRefGoogle Scholar
  18. 18.
    American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care 2018;Suppl 1:S13-S27.Google Scholar
  19. 19.
    National Diabetes Prevention Program: Curricula and Handouts: Centers for Disease Control and Prevention; 2018 [cited 2019 April 23]. Available from: https://www.cdc.gov/diabetes/prevention/lifestyle-program/curriculum.html.
  20. 20.
    Maruthur NM, Ma Y, Delahanty LM, Nelson JA, Aroda V, White NH, et al. Early response to preventive strategies in the Diabetes Prevention Program. J Gen Intern Med 2013;28(12):1629–36.CrossRefGoogle Scholar
  21. 21.
    Kandula NR, Moran MR, Tang JW, O’Brien MJ. Preventing Diabetes in Primary Care: Providers’ Perspectives About Diagnosing and Treating Prediabetes. Clin Diabetes 2018;36(1):59–66.CrossRefGoogle Scholar
  22. 22.
    Mainous AG, 3rd, Tanner RJ, Baker R. Prediabetes Diagnosis and Treatment in Primary Care. J Am Board Fam Med 2016;29(2):283–5.CrossRefGoogle Scholar
  23. 23.
    Jay M, Gillespie C, Schlair S, Sherman S, Kalet A. Physicians’ use of the 5As in counseling obese patients: is the quality of counseling associated with patients’ motivation and intention to lose weight? BMC Health Serv Res 2010;10:159.CrossRefGoogle Scholar
  24. 24.
    Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians’ weight loss counseling in two public hospital primary care clinics. Acad Med 2004;79(2):156–61.CrossRefGoogle Scholar
  25. 25.
    Post RE, Mainous AG, 3rd, Gregorie SH, Knoll ME, Diaz VA, Saxena SK. The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med 2011;171(4):316–21.CrossRefGoogle Scholar
  26. 26.
    Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro J. Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data. Int J Obes 2013;37(1):118–28.CrossRefGoogle Scholar
  27. 27.
    Tseng E, Yeh HC, Maruthur NM. Metformin Use in Prediabetes among U.S. Adults, 2005-2012. Diabetes Care 2017;40(7):887–93.CrossRefGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention. National Diabetes Prevention Program. 2018; [cited 2019 April 23]. Available from: https://www.cdc.gov/diabetes/prevention/index.html
  29. 29.
    American Medical Association. Prevent Diabetes STAT. 2019; [cited 2019 April 23]. Available from: https://preventdiabetesstat.org/index.html
  30. 30.
    National Institute of Diabetes and Digestive and Kidney Diseases and Centers for Disease Control and Prevention. National Diabetes Education Program 2018; [cited 2019 April 23]. Available from: https://www.niddk.nih.gov/health-information/communication-programs/ndep
  31. 31.
    Centers for Disease Control and Prevention. National Diabetes Education Program. 2018; [cited 2019 April 23]. Available from: https://www.cdc.gov/diabetes/ndep/index.html
  32. 32.
    Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144(10):742–52.CrossRefGoogle Scholar
  33. 33.
    Meigs JB, Cagliero E, Dubey A, Murphy-Sheehy P, Gildesgame C, Chueh H, et al. A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project. Diabetes Care 2003;26(3):750–7.CrossRefGoogle Scholar
  34. 34.
    Raz DJ, Wu GX, Consunji M, Nelson R, Sun C, Erhunmwunsee L, et al. Perceptions and Utilization of Lung Cancer Screening Among Primary Care Physicians. J Thorac Oncol 2016;11(11):1856–62.CrossRefGoogle Scholar
  35. 35.
    Venkataramani M, Cheng TL, Solomon BS, Pollack CE. Addressing Parental Health in Pediatrics: Physician Perceptions of Relevance and Responsibility. Clin Pediatr (Phila) 2017;56(10):953–8.CrossRefGoogle Scholar
  36. 36.
    Xierali IM, Nivet MA. The racial and ethnic composition and distribution of primary care physicians. J Health Care Poor Underserved 2018;29(1):556–570.CrossRefGoogle Scholar
  37. 37.
    Petterson S, McNellis R, Klink K, Meyers D, Bazemore A. The State of Primary Care in the United States: A Chartbook of Facts and Statistics. 2018.Google Scholar
  38. 38.
    Wright JD, Marsden PV. Handbook of Survey Research. 2nd ed. San Diego, CA: Elsevier; 2010.Google Scholar
  39. 39.
    O’Brien MJ, Moran MR, Tang JW, Vargas MC, Talen M, Zimmermann LJ, et al. Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention. Diabetes Educ 2016;42(6):667–77.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Eva Tseng
    • 1
    • 2
    Email author
  • Raquel C. Greer
    • 1
    • 2
  • Paul O’Rourke
    • 3
  • Hsin-Chieh Yeh
    • 1
    • 2
    • 4
  • Maura M. McGuire
    • 1
    • 5
  • Ann L. Albright
    • 6
  • Jill A. Marsteller
    • 7
  • Jeanne M. Clark
    • 1
    • 2
    • 4
  • Nisa M. Maruthur
    • 1
    • 2
    • 4
  1. 1.Division of General Internal Medicine The Johns Hopkins UniversityBaltimoreUSA
  2. 2.Welch Center for Prevention, Epidemiology, & Clinical ResearchThe Johns Hopkins UniversityBaltimoreUSA
  3. 3.Division of General Internal MedicineJohns Hopkins Bayview Medical CenterBaltimoreUSA
  4. 4.Department of EpidemiologyThe Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Johns Hopkins Community PhysiciansBaltimoreUSA
  6. 6.Division of Diabetes TranslationCenters for Disease Control and PreventionAtlantaUSA
  7. 7.Department of Health Policy and ManagementThe Johns Hopkins University Bloomberg School of Public HealthBaltimoreUSA

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