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.
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