PCPs' Knowledge of Prediabetes Management May Be Lacking, Survey Finds

A survey designed to assess knowledge of prediabetes among primary care providers (PCPs) finds that their awareness of risk factors and management strategies is lower than ideal.

Results of the study, conducted by researchers from Johns Hopkins University, were published recently in the Journal of General Internal Medicine. The study authors administered a survey to 155 PCPs attending an annual retreat for mid-Atlantic practices. Along with collecting provider information like gender, race/ethnicity, specialty, provider type, and years since training, the survey assessed respondents’ knowledge, management, and attitudes and beliefs about prediabetes.

Specifically, it asked the PCPs to identify the prediabetes risk factors on a list of several factors, as well as answer questions on screening, laboratory criteria, management approaches, and follow-up schedules. Respondents were asked to rate on a 5-point scale how much they agreed that identifying prediabetes is important and whether lifestyle modification and metformin can lower the risk of patients advancing to diabetes. They were also asked for their opinions on patient barriers to lifestyle modification and metformin.

The researchers found that just 6% of the PCPs accurately selected all of the risk factors that should prompt screening for prediabetes, as determined by the American Diabetes Association (ADA). Furthermore, 17% correctly identified the laboratory criteria for a diagnosis based on fasting glucose levels and hemoglobin A1C.

Just 11% of providers said they would refer patients with prediabetes to a behavioral weight loss program, such as the Diabetes Prevention Program, as an initial management approach, although these are recommended by the ADA as the preferred initial approach. In contrast, 96% of respondents selected counseling on diet and physical activity as their initial strategy.

Providers did agree that patients face significant barriers to lifestyle change and metformin use, and 90% reported they follow up with patients with prediabetes within 6 months. Taken together, these findings indicate that PCPs are interested in supporting patients with prediabetes, but may not be sure of exactly how to do so.

“Primary care providers play a vital role in screening and identifying patients at risk for developing diabetes,” senior author Nisa Maruthur, MD, MHS, assistant professor of medicine, said in a press release from Johns Hopkins University School of Medicine. “This study highlights the importance of increasing provider knowledge and availability of resources to help patients reduce their risk of diabetes.”

The press release mentioned Johns Hopkins’ efforts to implement a CDC-recognized lifestyle change program in East Baltimore, where the school is located. In the Power to Stop Diabetes program, pastors and community members are trained as lifestyle coaches who “help fellow community members manage weight, eat more healthfully and increase physical activity.”