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The national guidelines and recommendations for diabetes prevention focused on screening for prediabetes are useful in my practice. Diabetes prevention should be focused on individuals with lab values indicating abnormal blood glucose consistent with prediabetes. *Diabetes prevention should be a focus for all patients, regardless of blood glucose levels. Diagnosing a patient as being prediabetic is an effective way to increase patient awareness of their need for treatment. *Diagnosing prediabetes is misleading to patients regarding them having a disease. *Diagnosing a patient with prediabetes risks overtreatment. Current evidence supports the utility of screening for prediabetes. Current evidence supports the effectiveness of treating prediabetes. Each item was answered using a 5-point scale (1, strongly disagree, to 5, strongly agree).
↵* Items were reverse coded so that on the summated index, a higher score on the index represented a more positive attitude toward the construct of prediabetes.
Guideline Source Guideline American Diabetes Association Testing to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and who have ≥1 additional risk factor for diabetes. For all patients, testing should begin at age 45 years.1 US Preventive Services Task Force Screening for abnormal blood glucose is recommended as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese.14 BMI, body mass index.
Total Positive Attitude Toward Prediabetes Less Positive Attitude Toward Prediabetes P Value Sex <.0001 Male 50.4 44.8 57.5 Female 49.6 55.2 42.5 Age (years) .003 20–29 0.3 27.4 19.5 30–39 24.2 32 30.2 40–49 30.9 24.3 27.8 50–59 25.3 16.3 22.5 ≥60 19.3 Race .04 Hispanic 4.4 5.1 3.2 Non-Hispanic white 81.8 79.9 86.5 Non-Hispanic black 4.4 4.6 3 Asian/other 9.4 10.5 7.3 Rank .002 Assistant professor 38.4 42.8 33.0 Associate professor 30.2 29.6 30.6 Full professor 20.2 16.7 25.1 Visiting professor 0.2 0.2 0.2 Not applicable 11 10.8 11.1 Terminal Degree .008 MD 90.7 89.4 93.5 DO 8.9 10.6 6.1 Other 0.4 0 0.4 Half days in the clinic (n) .54 <3 49.4 47.7 50.2 3 to 6 45.3 46.6 45.3 ≥7 5.3 5.7 4.5 Years in practice .003 1–10 29.6 32.2 25.2 11–20 31.4 33.3 29.6 21–30 23.1 21 26.2 >30 15.9 13.5 19 Proportion of patients with diabetes .04 <10% 11.1 11.2 10.9 10–24% 55.1 52.5 59.6 25–49% 29.8 31.2 27 ≥50% 4.0 5.1 2.5 Proportion of patients with prediabetes .06 <10% 21.5 20.5 22.6 10–24% 58.9 57.6 61.4 25–49% 17.4 19 14.7 ≥50% 2.2 2.9 1.3 Attitudes toward prediabetes Range 13–37 Median 27 Data are percentages unless otherwise indicated.
Total Positive Attitude Toward Prediabetes Less Positive Attitude Toward Prediabetes P Value Most family physicians do not consider screening for prediabetes to be a high priority in diabetes prevention. <.0001 Disagree/strongly disagree 56.1 67.5 40.3 Neutral 26.7 21.1 34.7 Agree/strongly agree 17.2 11.4 25 I give general lifestyle advice targeted toward reducing cardiovascular disease instead of advice specific to diabetes to patients with abnormal blood glucose. <.0001 Disagree/strongly disagree 45.4 53.2 35.1 Neutral 17.0 17 17.6 Agree/strongly agree 37.6 29.8 47.4 Most patients cannot successfully comply with lifestyle changes needed for diabetes prevention. .0002 Disagree/strongly disagree 46.6 52.2 39.5 Neutral 23.1 20.7 26.2 Agree/strongly agree 30.4 27.1 34.3 I recommend metformin to most patients with prediabetes. <.0001 Disagree/strongly disagree 42.9 36.5 52.4 <.0001 Neutral 27.1 27.1 26.6 Agree/strongly agree 30.0 36.4 20.9 Primary lifestyle change stressed .01 Changing diet 20.7 21.2 19.1 Increasing leisure time physical activity 10.0 7.5 13.6 Weight loss 11.3 11.7 10.4 Stress all 3 equally 58.0 59.6 57 Primary method of identifying someone at risk of developing diabetes .11 Assessing BMI 38.7 36.4 41.8 Testing blood glucose concentrations 52.1 55.3 48 Asking about family history 8.0 7.2 8.7 Other 1.2 1.1 1.5 Follow national guideline or screening recommendation <.0001 Yes 52.4 58.4 44.4 No 18.1 15 21.9 Don't know 29.5 26.5 33.8 Primary guideline followed .0001 American Diabetes Association 25.2 31 15.3 USPSTF current guidelines 35.5 31.8 43.5 USPSTF draft guidelines 2.0 1.3 3.4 Other/combination of guidelines 36.5 35.2 37.8 Don't know 0.8 0.8 0 Data are percentages unless otherwise indicated.
BMI, body mass index; USPSTF, US Preventive Services Task Force.
Perceived Barriers to Diabetes Prevention Total Positive Attitude Toward Prediabetes Less Positive Attitude Toward Prediabetes P Value Medication compliance .0002 Not a barrier/somewhat of a barrier 41.1 43.8 37.7 Neutral 19.5 15.3 25.1 A barrier/extreme barrier 39.4 41 37.2 Patient acceptance of prediabetes diagnosis .0001 Not a barrier/somewhat of a barrier 46.0 50.6 39.5 Neutral 24.1 20 29.7 A barrier/extreme barrier 29.9 29.4 30.8 Insurance coverage of education for patient .09 Not a barrier/somewhat of a barrier 31.8 34.6 29 Neutral 15.9 14.3 17.8 A barrier/extreme barrier 52.3 51.1 53.2 Patient ability to modify lifestyle .19 Not a barrier/somewhat of a barrier 15.0 16.8 13 Neutral 5.5 5 5.8 A barrier/extreme barrier 79.5 78.2 81.2 Time needed to educate patient on diet and lifestyle change .03 Not a barrier/somewhat of a barrier 16.4 19.2 13.2 Neutral 8.3 7.6 8.9 A barrier/extreme barrier 75.3 73.2 78 Insurance coverage for glucometers for patients .22 Not a barrier/somewhat of a barrier 45.2 46.8 43.6 Neutral 21.5 19.3 23.5 A barrier/extreme barrier 33.4 33.9 32.8 Economic resources of patients .3 Not a barrier/somewhat of a barrier 21.4 23.1 19.9 Neutral 6.7 5.9 7.6 A barrier/extreme barrier 71.9 71 72.5 Sustaining patient motivation .25 Not a barrier/somewhat of a barrier 11.6 13 10.4 Neutral 5.2 5.4 4.3 A barrier/extreme barrier 83.2 81.5 85.3 Time for patient follow-up .06 Not a barrier/somewhat of a barrier 26.3 29.1 23.2 Neutral 18.1 18 17.3 A barrier/extreme barrier 55.6 52.9 59.5 Not a barrier/somewhat of a barrier .06 Neutral 65.5 68.4 62 A barrier/extreme barrier 23.8 22.4 25.5 A barrier/extreme barrier 10.6 9.2 12.5 Data are percentages unless otherwise indicated.
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