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Diagnosis & Treatment of Prediabetes in Primary Care

J Am Board Fam Med; 2016 Mar-Apr; Mainous III, Tanner, et al

Publish date:

Missed opportunities may exist for diabetes prevention in primary care and clinicians may need to change their approach to prediabetes in order to play a more effective role in preventing the onset of diabetes. This according to an analysis of visits by adults aged ≥45 years without diagnosed diabetes who had an HbA1c test within 90 days of the visit. Researchers found:

• Among visiting adults, 54.6% had a normal HbA1c value; 33.6% had prediabetes; and 11.9% had diabetes.

• Of those patient visits with HbA1c consistent with prediabetes, the number of patients diagnosed with prediabetes was too low for a reliable population estimate.

• Indication of treatment in the medical record (lifestyle modification counseling and/or metformin) was present in only 23.0% of those with diagnosed or undiagnosed prediabetes.

• Three-fourths of those with prediabetes were not provided with an appropriate treatment plan.

Citation: Mainous AG, Tanner RJ, Baker R. Prediabetes diagnosis and treatment in primary care. J Am Board Fam Med. 2016;29(2):283-285. doi:10.3122/jabfm.2016.02.150252.

Commentary: This article suggests that the diagnosis of prediabetes is often not made, even when a third of patients have laboratory testing that is consistent with prediabetes. The diagnosis of prediabetes should be viewed as a call to action, since specific interventions can decrease the likelihood of progression from prediabetes to diabetes. The most important and most effective intervention is lifestyle modification, consisting of a target for weight loss of >7% of body weight, and >150 minutes per week of moderately strenuous exercise. This has been shown to decrease progression to diabetes by approximately 60%, which is significantly greater than that achieved with the use of oral hypoglycemic medications like metformin.1 Prediabetes presents a window of opportunity for prevention that should be addressed by both patients and physicians with promise and hope. ­—Neil Skolnik, MD

1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403. doi:10.1056/NEJMoa012512.

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