Perspective from Ann Lindsay, MD
Perspective from Richard J. Millstein, DO
Disclosures: The authors report no relevant financial disclosures.
February 23, 2021
2 min read
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Awareness of imminent diabetes diagnosis fails to change patients’ behavior

Perspective from Ann Lindsay, MD
Perspective from Richard J. Millstein, DO
Disclosures: The authors report no relevant financial disclosures.
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Adults who were aware of their prediabetes status were more likely than those who were unaware to report a perceived risk for diabetes, data show.

However, the risk awareness was not associated with a meaningful difference in dietary or physical activity behaviors, according to researchers.

The quote is: “It is important to talk with patients about what prediabetes is … and how to manage it.” The source of the quote is: Erica Li, MD.

Erica Li, MD, a family medicine specialist at Jefferson University Hospitals in Philadelphia, and colleagues conducted a secondary analysis of 2015 to 2016 National Health and Nutrition Examination Survey data. The survey assessed participants’ personal risk for developing diabetes, general health status, understanding of their weight and desire to lose weight.

From nearly 10,000 responders, the researchers’ final analysis included 389 participants who were previously told they had prediabetes and 410 participants who were never told they had prediabetes but had a HbA1c that was “borderline” for diabetes (between 5.7% and 6.4%). The groups were propensity-score matched based on BMI, HbA1c level, race and education. There were 21 responders who were unmatched, and their data were not included in measured analysis.

According to Li and colleagues, 275 of those in the prediabetes-aware group said they felt they were at risk for diabetes compared with 97 in the prediabetes-unaware group. Statistically significant differences between the prediabetes-aware vs. prediabetes-unaware cohorts, respectively, included:

  • number of participants who saw themselves as overweight (284 vs. 200), about the right weight (108 vs. 166) and underweight (17 vs. 22);
  • number of participants who wanted to weigh more than their current weight (23 vs. 31), stay about the same weight (79 vs. 117) and weigh less than current weight (308 vs. 240);
  • number of minutes typically spent doing moderate activity daily (55.6 vs. 80.45) and vigorous activity daily (73.94 vs. 95.64); and
  • number of minutes typically spent sitting daily (389.26 vs. 353.8).

“We found that patients who were aware of their prediabetes diagnosis were more likely to report being at risk for developing diabetes and were more likely to see themselves as overweight,” Li told Healio Primary Care. “However, those who were aware of their prediabetes status were not more likely to engage in healthier dietary or physical activity behaviors compared to those who were unaware.”

Li and colleagues wrote in the Journal of the American Board of Family Medicine that a 2016 national survey that appeared in Diabetes Care indicated some primary care providers felt use of the term “prediabetes” may lead to overdiagnosis and overtreatment, while another 2016 study in the same journal found use of the term provided patients with an incentive to participate in preventive behaviors. According to Li, the “controversial” nature of the term “prediabetes” keeps many PCPs from discussing the condition with patients. She encouraged her peers to facilitate, not discourage, prediabetes discussions.

“It is important to talk with patients about what prediabetes is, what it means about the risk of developing diabetes in the future, and how to manage it,” she said. “Emphasize that prediabetes can be treated and adopting a healthier lifestyle will have many benefits, including preventing diabetes.”

Li added that referring patients with prediabetes to the National Diabetes Prevention Program and discussing, recognizing and finding solutions to barriers to making lifestyle changes could help more patients take steps to prevent diabetes.