I am not sure the ADA actually said
this. “According to the ADA, if A1C is between 5.7-6.4%, the
patient is considered prediabetic and should be treated with
lifestyle modifications and possibly metformin therapy.” But this
is what the author of the article stated and I hope it is true, as a
prediabetes diagnosis is a last call for patients to take action to
possibly prevent a lifelong battle with diabetes.
As I explained in this blog, many
doctors won't treat prediabetes in the hopes that they will soon have
a patient with type 2 diabetes that they can treat. They use words
like, “watch what you eat, as your blood sugar is elevated.” We
know this is code for prediabetes and these doctors are licking their
chops knowing they will soon have a captive patient to treat. I must
state that not all doctors are this callus and do diagnosis
prediabetes, but then fail to help the patient.
A new article published in Journal of
the American Board of Family Medicine (JABFM) states that only 23% of
prediabetes patients were diagnosed by their healthcare providers and
started on appropriate therapy. Researchers looked at the data from
the 2012 National Ambulatory Medical Care Survey, which included
adults over 45 years of age with no diabetes and their A1C tested
within the last 90 days. A1C results were categorized as normal,
prediabetes, or diabetes and were broken down based on age, sex,
race, payer type, body mass index, and prediabetes treatment.
A total of 518 visits were analyzed.
The survey found that 54.6% of participants had a normal A1C, 33.6%
had prediabetes, and 11.9% had diabetes. Only 23.0% of patients
categorized as having prediabetes received treatment; the most common
was counseling on lifestyle modifications. Rates of prediabetes were
similar between men (36.5%) and women (40.0%). The most frequent
primary diagnosis was hypertensive disease (16.3%). There were no
noticeable differences in applied treatments based on HbA1c level
range whether patients had an HbA1c level of 5.7% or 6.4%.
This proves the doctors don't have the
best interests of their patients in mind and are afraid of diabetes
and prediabetes. Why they won't prescribe metformin is unknown.
This is a generic diabetes medication, very inexpensive, and many
endocrinologists do prescribe it “off-label.” It is the safest
diabetes drug available and while not FDA approved for prediabetes,
it still needs to be prescribed.
Primary care physicians (PCPs) should
play an active role in the lives of their patients who have
prediabetes and diabetes. The increasing prevalence of diabetes is a
major health problem and the American Diabetes Association recommends
screening for prediabetes in all individuals over 44 years of age and
children who are obese.
When patients do have elevated A1C,
PCPs must intervene. By providing them counseling and medication
therapy, and following up with them, PCPs can influence patients’
lives by delaying the onset of diabetes, or perhaps even preventing
patients from transitioning to diabetes. Prevention is the most
effective strategy to treat diabetes that we have so far, and can
greatly improve the overall quality of life of an affected patient as
well as help lower the total cost of healthcare for all of us.
In the last ten days, I have been in
email correspondence with three individuals that actually asked for
and received copies of their lab reports. All three had A1c's in the
prediabetes range and asked what they should be doing. All stated
that the doctor had made a statement like the one in the second
paragraph above. I asked if they had insurance and explained that
metformin would probably not be covered, but they should check this
and testing supplies. If insurance would not cover any of this, they
should investigate purchasing testing supplies from a pharmacy that
was low cost and known for this. They needed to talk to their doctor
about prescribing metformin ER (extended release) or even just
metformin as it was a low cost generic.
Two of the individuals said their
doctor would not prescribe metformin and I suggested they get a
referral to an endocrinologist or lacking this, getting an
appointment with one. Then they should talk to the endocrinologist
about a prescription for metformin. They said they would and I have
told all three that I would work with them on “eating to their
meter” and learning what the meter readings were telling them.
This is one reason I promote obtaining
your lab reports so that you will know what the results are and if
there is need for concern and action on your part. I would suggest
reading this article in Diabetes-in-Control.
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