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

James W. Keck; Alisha R. Thomas; Laura Hieronymus; Karen L. Roper

doi:10.3122/jabfm.2019.04.180375

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Table 1.

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

Prediabetes Question	Correct Answer	Answered Correctly (N = 31)
Fasting glucose range indicative of prediabetes	100 to 125 mg/dL²⁹	21 (67.7%)
Hemoglobin A1c range indicative of prediabetes	5.7 to 6.4%²⁹	30 (96.8%)
It is recommended that prediabetics lose what proportion of their starting weight?	5% to 7%²⁹	10 (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 moderate²⁹	21 (67.7%)
How often should you routinely screen for diabetes?	Every three years^26,29	12 (38.7%)

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Table 2.

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

	Strongly Agree or Agree	Neither Agree nor Disagree	Strongly Disagree or Disagree
Prediabetes attitudes
Prediabetes is a significant public health issue	29 (93.6%)	2 (6.5%)	0 (0.0%)
Most primary care providers consider screening for prediabetes to be a high priority	20 (64.5%)	5 (16.1%)	6 (19.3%)
The diagnosis of prediabetes leads to further unnecessary investigation/testing	1 (3.2%)	5 (16.1%)	25 (80.6%)
Diagnosing prediabetes is an effective way to increase patient awareness of their need for lifestyle modification	31 (100.0%)	0 (0.0%)	0 (0.0%)
Evidence supports the effectiveness of treating prediabetes with lifestyle modification	31 (100.0%)	0 (0.0%)	0 (0.0%)
Using metformin will reduce progression to diabetes	25 (80.6%)	4 (12.9%)	2 (6.5%)
I am confident in my ability to manage prediabetes	27 (87.1%)	2 (6.5%)	2 (6.5%)
DPP awareness
I am familiar with National DPPs	14 (45.2%)	7 (22.6%)	10 (32.3%)
I know how to refer a patient to a National DPP	15 (48.4%)	1 (3.2%)	15 (48.4%)
I am aware of local organizations that offer National DPPs	13 (41.9%)	3 (9.7%)	15 (48.4%)
I am aware of insurance plans that pay for National DPPs	5 (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 behaviors	11 (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 diabetes	22 (71.0%)	6 (19.4%)	3 (9.7%)
I expect prediabetic patients who complete a National DPP will have resolution of their prediabetes	5 (16.1%)	18 (58.1%)	8 (25.8%)

DPP, National Diabetes Prevention Program.

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Table 3.

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

Prediabetes Care Practice	For What Proportion^* of Your Prediabetic Patients Do you Perform the Following Management Practices…
Prediabetes Care Practice	None	Some	Most
Discuss metformin as a treatment option	0 (0.0%)	14 (45.2%)	17 (54.8%)
Prescribe metformin	2 (6.5%)	19 (61.3%)	10 (32.3%)
Recommend physical activity targets supported by national guidelines	0 (0.0%)	4 (12.9%)	27 (87.1%)
Have patient set a weight loss goal of 5% to 7% of their current weight	4 (12.9%)	16 (51.6%)	11 (35.5%)
Recommend nutritional counseling	0 (0.0%)	10 (32.3%)	21 (67.7%)
Create a behavioral contract	25 (80.7%)	6 (19.4%)	0 (0.0%)
Provide pamphlets or other written resources	7 (22.6%)	18 (58.1%)	6 (19.4%)
Offer referral to a CDC-recognized National DPP	10 (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%.

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Table 4.

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

	All Patients		Prediabetes Diagnosis^*
	N	%	N	%
	15,250	100	2,412	15.8%
Demographic
Age, years (mean, SD)	49.3	16.4	58.2	13.3
Female	8,606	56.4%	1,255	52.0%
Race
White	11,967	78.5%	1,790	74.2%
Black/African American	2,474	16.2%	517	21.4%
Asian	566	3.7%	76	3.2%
AI/AN, Hawaiian, PI	79	0.5%	15	0.6%
Unreported	164	1.1%	14	0.6%
Health insurance
Private	8,145	53.4%	1,109	46.0%
Medicare	3,049	20.0%	780	32.3%
Medicaid	3,011	19.7%	399	16.5%
Tricare	291	1.9%	30	1.2%
Financial assistance	164	1.1%	25	1.0%
None	590	3.9%	69	2.9%
Clinical characteristics
BMI ≥25kg/m2	11,454	75.1%	2,122	88.0%
Hemoglobin A1c test	10,095	66.2%	2,360	97.8%
Diabetes diagnosis^†	2,463	16.2%	561	23.3%

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.

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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 Cascade	Criteria	n	%
USPSTF diabetes screening eligible	Nondiabetic patient	12,787	83.8%
USPSTF diabetes screening eligible	Age 40 to 70 years + BMI ≥25 kg/m²	5,360	41.9%
Screened	Hemoglobin A1c within 3 years	4,068	75.9%
Prediabetes diagnosed	Hemoglobin A1c of 5.7 to 6.4%	1,437	35.3%
Prediabetes documented	Prediabetes ICD10 code	729	50.7%
Prediabetes treatment	Metformin prescribed	149	20.4%
Prediabetes treatment	DPP referral	0	0.0%

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.