November 25, 2016
Guidelines for Prediabetes Screening not Followed
On November 9, Brenda called and asked if I had read about physicians not following the guidelines forprediabetes screening. I told her that I had not, but it was on the list to read. She said that Dr. Tom had called her and felt this would be a good topic for a group meeting.
I said I did not agree, but I would go along with the majority. I suggested she send out an email to our group and ask for their approval or reasons against it. I also suggested she send a similar email to Glen and Dr. Tom to discuss with their members to find out how many would attend. She agreed and I asked her if she could read Medscape articles. She answered no and I said I would send her a copy of one and instructions on how to join. I stated that I felt this could be more valuable for a group meeting, but I would not oppose what Dr. Tom had proposed.
The identification and treatment of prediabetes is one of the most effective ways to prevent patients from developing diabetes, but a new University of Florida study finds that only about half of family physicians report following national guidelines for screening patients for prediabetes.
Physicians also said that patient factors, such as sustaining a patient's motivation to make lifestyle changes, were significant barriers to diabetes prevention. The findings were published November 8 in the Journal of the American Board of Family Medicine.
More than a third of U.S. adults have prediabetes and most don't know it. Prediabetes, which is characterized by having blood glucose concentrations higher than normal, but not high enough for a diabetes diagnosis, can lead to vascular problems, kidney disease, and nerve and retinal damage. It is one of the greatest risk factors for the development of diabetes.
A previous study led by Arch G. Mainous III, Ph.D., chair of the department of health services research, management and policy in the UF College of Public Health and Health Professions, part of UF Health, found that very few patients who met the criteria for prediabetes were told by their doctors they had the condition. Less than one-quarter of those patients received drug or lifestyle modification treatment.
"For our next study we wanted to find out why the detection and treatment of prediabetes is so low when we know what the guidelines say about diagnosis and treatment and that many millions of Americans have this condition," said Mainous, the Florida Blue endowed chair of health administration. "We know from the literature that there are some different points of view on prediabetes. Some physicians think that a prediabetes diagnosis 'over medicalizes' patients, and some believe it is best to focus on providing general advice on healthy lifestyle."
The American Diabetes Association recommends that all adults who are overweight or obese or over the age of 45 should be screened for prediabetes. The U.S. Preventive Services Task Force recommends prediabetes screening for adults age 40 to 70 who are overweight or obese. Prediabetes treatment plans include drug therapy or intensive lifestyle modification.
The new UF study surveyed more than 1,200 family physicians working in an academic medical setting, asking them to rate the strength of the current evidence for prediabetes screening and treatment, the costs and benefits of formally diagnosing patients with prediabetes and the value in focusing on prediabetes as a way to prevent diabetes.
The researchers found that physicians who have a positive attitude toward prediabetes as a clinical condition were more likely to follow national guidelines for prediabetes screening and to offer treatment for their patients. Physicians who hold a negative attitude toward prediabetes were more likely to recommend to their patients general lifestyle changes that may reduce cardiovascular disease risk, but are not associated with lowering blood glucose levels.
"I'm hoping that we can change physician attitudes so that they follow and trust the screening and treatment guidelines, which are evidence-based, and view it as a worthwhile way to prevent diabetes," Mainous said.
Another key finding is that regardless of whether they hold a positive or negative attitude toward prediabetes, the majority of physicians surveyed indicated there are several patient barriers to diabetes prevention, including a patient's economic resources, sustaining patient motivation, a patient's ability to modify his or her lifestyle and time to educate patients.
"This suggests we need to provide new resources for physicians to support them in helping patients make lifestyle changes," Mainous said.