November 14, 2016
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National prediabetes screening guidelines not universally accepted

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Approximately 18% of clinicians surveyed do not follow national prediabetes screening guidelines and another 29% were not sure if they were, according to study findings published in the Journal of the American Board of Family Medicine.

Physicians who reported a positive attitude regarding toward prediabetes as a clinical construct were more likely to follow established guidelines for screening.

“Given the evidence that prediabetes is underdiagnosed and treated, it is important to understand primary care physicians’ apparent reluctance to screen for and manage prediabetes. It has been suggested that identifying and labeling patients as having a ‘predisease,’ in particular prediabetes, is overdiagnosis,” Arch G. Mainous III, PhD, department of health services research, management and policy, University of Florida, and colleagues wrote. “We sought to use a set of potential attitudes as a discriminator for practice patterns regarding prediabetes. Understanding why prediabetes is not acknowledged and why treatment plans are infrequently provided is critical for successful interventions to improve diabetes prevention.”

Mainous and colleagues evaluated responses from 1,248 physicians to determine their attitudes towards prediabetes. Thirty percent of responders had 10 years or less experience and nearly half spent fewer than 3 days a week in patient care.

Physician attitudes

Clinicians were asked their opinions about prediabetes, rating items on a scale of one to five, with five indicating they strongly agreed. The items included: current evidence supporting the utility of screening for prediabetes; the effectiveness of treating it; the danger of overtreatment; the possibility of deceiving patients into thinking they have prediabetes; whether the diagnosis would help patients understand their need for treatment; the role that blood glucose levels play in discussing prediabetes; and the usefulness of the national guidelines. Researchers split the index of scores at the median; a score greater than or equal to 27 would indicate a positive attitude toward prediabetes as a diagnostic construct. The range of these scores was 13 to 37, and those clinicians with positive attitudes regarding the diagnosis and treatment of prediabetes were more likely to follow the national guidelines. (58.4% vs. 44.4%; P < .0001)

“Importantly, respondents who had a more negative set of attitudes toward prediabetes were less likely to believe that patients can successfully follow lifestyle changes needed for diabetes prevention, were less likely to recommend metformin to patients with prediabetes, and were less likely to agree that screening for prediabetes is a high priority for family physicians,” Mainous and colleagues wrote. “They were also more likely to recommend a general lifestyle aimed at reducing cardiovascular disease, potentially encompassing a concept like the metabolic syndrome, rather than advice tailored toward lowering blood glucose concentrations.”

Possible barriers

Clinicians were also asked about potential obstacles to diabetes prevention, such as familiarity of treatment; follow-up time; patient’s insurance coverage of education sessions and glucometers; patient’s acceptance of the diagnosis; adherence to medication; patient’s economic resources; maintaining the patient’s motivation ability to change lifestyle; and time to educate patients. Responders ranked these obstacles from one to five, with five being an “extreme” barrier; the last four of these obstacles were among the most prevalent.

“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 in a press release. – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.