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Research ArticleOriginal Research

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

James W. Keck, Alisha R. Thomas, Laura Hieronymus and Karen L. Roper
The Journal of the American Board of Family Medicine July 2019, 32 (4) 505-512; DOI: https://doi.org/10.3122/jabfm.2019.04.180375
James W. Keck
the Department of Family & Community Medicine, University of Kentucky College of Medicine, Lexington (JWK, KLR); Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington (JWK, ART); Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington (HL).
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Alisha R. Thomas
the Department of Family & Community Medicine, University of Kentucky College of Medicine, Lexington (JWK, KLR); Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington (JWK, ART); Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington (HL).
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Laura Hieronymus
the Department of Family & Community Medicine, University of Kentucky College of Medicine, Lexington (JWK, KLR); Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington (JWK, ART); Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington (HL).
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Karen L. Roper
the Department of Family & Community Medicine, University of Kentucky College of Medicine, Lexington (JWK, KLR); Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington (JWK, ART); Barnstable Brown Diabetes Center, University of Kentucky College of Medicine, Lexington (HL).
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Article Figures & Data

Tables

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    Table 1.

    Clinician Knowledge of Prediabetes Diagnosis and Treatment at an Academic Family Medicine Practice

    Prediabetes QuestionCorrect AnswerAnswered Correctly (N = 31)
    Fasting glucose range indicative of prediabetes100 to 125 mg/dL2921 (67.7%)
    Hemoglobin A1c range indicative of prediabetes5.7 to 6.4%2930 (96.8%)
    It is recommended that prediabetics lose what proportion of their starting weight?5% to 7%2910 (32.3%)
    How much physical activity per week should be recommended for patients with prediabetes, assuming they have no other health issues?75 minutes vigorous; 150 minutes moderate2921 (67.7%)
    How often should you routinely screen for diabetes?Every three years26,2912 (38.7%)
    • View popup
    Table 2.

    Clinician Prediabetes Attitudes and Diabetes Prevention Program Awareness at an Academic Family Medicine Practice

    Strongly Agree or AgreeNeither Agree nor DisagreeStrongly Disagree or Disagree
    Prediabetes attitudes
        Prediabetes is a significant public health issue29 (93.6%)2 (6.5%)0 (0.0%)
        Most primary care providers consider screening for prediabetes to be a high priority20 (64.5%)5 (16.1%)6 (19.3%)
        The diagnosis of prediabetes leads to further unnecessary investigation/testing1 (3.2%)5 (16.1%)25 (80.6%)
        Diagnosing prediabetes is an effective way to increase patient awareness of their need for lifestyle modification31 (100.0%)0 (0.0%)0 (0.0%)
        Evidence supports the effectiveness of treating prediabetes with lifestyle modification31 (100.0%)0 (0.0%)0 (0.0%)
        Using metformin will reduce progression to diabetes25 (80.6%)4 (12.9%)2 (6.5%)
        I am confident in my ability to manage prediabetes27 (87.1%)2 (6.5%)2 (6.5%)
    DPP awareness
        I am familiar with National DPPs14 (45.2%)7 (22.6%)10 (32.3%)
        I know how to refer a patient to a National DPP15 (48.4%)1 (3.2%)15 (48.4%)
        I am aware of local organizations that offer National DPPs13 (41.9%)3 (9.7%)15 (48.4%)
        I am aware of insurance plans that pay for National DPPs5 (16.1%)4 (12.9%)22 (71.0%)
        I expect prediabetic patients who complete a National DPP will have long-term changes in their health behaviors11 (35.5%)13 (41.9%)7 (22.6%)
        I expect prediabetic patients who complete a National DPP will have a reduced chance of progressing to diabetes22 (71.0%)6 (19.4%)3 (9.7%)
        I expect prediabetic patients who complete a National DPP will have resolution of their prediabetes5 (16.1%)18 (58.1%)8 (25.8%)
    • DPP, National Diabetes Prevention Program.

    • View popup
    Table 3.

    Clinician-Reported Frequency of Prediabetes Care Practices at an Academic Family Medicine Practice

    Prediabetes Care PracticeFor What Proportion* of Your Prediabetic Patients Do you Perform the Following Management Practices…
    NoneSomeMost
    Discuss metformin as a treatment option0 (0.0%)14 (45.2%)17 (54.8%)
    Prescribe metformin2 (6.5%)19 (61.3%)10 (32.3%)
    Recommend physical activity targets supported by national guidelines0 (0.0%)4 (12.9%)27 (87.1%)
    Have patient set a weight loss goal of 5% to 7% of their current weight4 (12.9%)16 (51.6%)11 (35.5%)
    Recommend nutritional counseling0 (0.0%)10 (32.3%)21 (67.7%)
    Create a behavioral contract25 (80.7%)6 (19.4%)0 (0.0%)
    Provide pamphlets or other written resources7 (22.6%)18 (58.1%)6 (19.4%)
    Offer referral to a CDC-recognized National DPP10 (32.3%)21 (67.7%)0 (0.0%)
    • CDC, Centers for Disease Control and Prevention; DPP, Diabetes Prevention Program.

    • ↵* Respondents selected between 0%, 25%, 50%, 75%, and 100%.

    • “None” indicates 0%; “Some” includes 25% and 50%; “Most” includes 75% and 100%.

    • View popup
    Table 4.

    Demographic and Clinical Characteristics of Adult Patients with and without Prediabetes Diagnosis at an Academic Family Medicine Practice, 2014 to 2017

    All PatientsPrediabetes Diagnosis*
    N%N%
    15,2501002,41215.8%
    Demographic
        Age, years (mean, SD)49.316.458.213.3
        Female8,60656.4%1,25552.0%
        Race
        White11,96778.5%1,79074.2%
        Black/African American2,47416.2%51721.4%
        Asian5663.7%763.2%
        AI/AN, Hawaiian, PI790.5%150.6%
        Unreported1641.1%140.6%
    Health insurance
        Private8,14553.4%1,10946.0%
        Medicare3,04920.0%78032.3%
        Medicaid3,01119.7%39916.5%
        Tricare2911.9%301.2%
        Financial assistance1641.1%251.0%
        None5903.9%692.9%
    Clinical characteristics
        BMI ≥25kg/m211,45475.1%2,12288.0%
        Hemoglobin A1c test10,09566.2%2,36097.8%
        Diabetes diagnosis†2,46316.2%56123.3%
    • AI/AN, American Indian/Alaska Native; BMI, body mass index; PI, Pacific Islander; SD, standard deviation.

    • ↵* Prediabetes diagnosis defined as documented International Classification of Disease version 10 (ICD10) code R73.03 in patient chart.

    • ↵† Diabetes diagnosis determined by ICD10 code in patient chart. For patients with prediabetes code this indicates a dual diagnostic codes.

    • View popup
    Table 5.

    Prediabetes Care Cascade: Screening, Diagnosis, and Treatment Coverage of Adult Patients at an Academic Family Medicine Practice, 2014 to 2017 (N = 15,250)

    Prediabetes Care CascadeCriterian%
    USPSTF diabetes screening eligibleNondiabetic patient12,78783.8%
    Age 40 to 70 years + BMI ≥25 kg/m25,36041.9%
    ScreenedHemoglobin A1c within 3 years4,06875.9%
    Prediabetes diagnosedHemoglobin A1c of 5.7 to 6.4%1,43735.3%
    Prediabetes documentedPrediabetes ICD10 code72950.7%
    Prediabetes treatmentMetformin prescribed14920.4%
    DPP referral00.0%
    • BMI, body mass index; DPP, Diabetes Prevention Program; ICD10, International Classification of Diseases, version 10; USPSTF, United States Preventive Services Task Force.

    • The sample size for each row serves as the denominator for the subsequent row.

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The Journal of the American Board of Family     Medicine: 32 (4)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 4
July-August 2019
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Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice
James W. Keck, Alisha R. Thomas, Laura Hieronymus, Karen L. Roper
The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 505-512; DOI: 10.3122/jabfm.2019.04.180375

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Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice
James W. Keck, Alisha R. Thomas, Laura Hieronymus, Karen L. Roper
The Journal of the American Board of Family Medicine Jul 2019, 32 (4) 505-512; DOI: 10.3122/jabfm.2019.04.180375
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