Clinically excellent clinicians effectively counsel and motivate patients to prevent diabetes. Setting specific goals for lifestyle changes, referring to evidence-based Diabetes Prevention Programs, and scheduling timely follow-up visits are among the tips outlined.
Lifelong Learning in Clinical Excellence | October 2, 2019 | 2 min read
By Eva Tseng, MD, MPH, Johns Hopkins Medicine
As clinicians, we prefer to prevent rather than to treat a disease. Fortunately, diabetes is a condition we can prevent!
Prediabetes affects one in three adults in the U.S., but only one out of ten people with prediabetes are aware that they have it. As a primary care doctor, I know that prediabetes often falls low in priority on a long list of chronic medical conditions that we must address with our patients. It is easier for us to overlook the conditions that haven’t occurred and focus on the pressing and existing conditions that our patients already have.
There are simply not enough resources dedicated to preventing prediabetes in primary care. Our recent survey of primary care physicians, published in the Journal of General Internal Medicine, showed that doctors overwhelmingly agree that system-level changes are important and necessary to support diabetes prevention.
Until these resources are widely available, here are some suggestions for discussing prediabetes with your patients:
1.Prediabetes is a condition that puts patients at higher risk of developing diabetes compared to someone without prediabetes. The good news is that there is strong evidence that diabetes can be prevented without medication.
2. Discuss basic lifestyle changes patients can make, which can also improve hypertension, obesity, and other conditions.
Set specific goals for physical activity (e.g., let’s start with brisk walking 20 minutes twice a week around your work building) to help them eventually get to the recommended goal (150 minutes per week of moderate-intensity physical activity) and for weight loss (e.g., I see you weigh 180lbs so let’s start with 5% weight loss, or about 10lbs) to get to the recommended goal (7% weight loss).
3. Ask if they are interested in participating in the Diabetes Prevention Program (DPP), an evidence-based program recognized by the CDC and covered by Medicare and Medicaid in certain states. More private insurers are starting to cover DPPs. DPP is a yearlong lifestyle change program run by trained lifestyle coaches that meet in-person or online.
4. Help your patients look for available programs through the CDC website.
In my home state of Maryland, the Department of Health maintains a website with local and available DPP offerings, including online programs.
5. Discuss that metformin is also a medication we use to treat prediabetes and that we might consider if efforts to attain lifestyle change fail, if they prefer medication, if they have a BMI ≥35kg/m², age<60 years, women with prior gestational diabetes.
6. Follow-up and address prediabetes at subsequent visits.
Check labs to monitor for progression to diabetes at least once a year.