Survey says physicians unprepared to help patients prevent diabetes

A survey of randomly selected primary care physicians showed significant gaps in overall knowledge of risk factors, diagnostic criteria, and recommended management and prevention practices for prediabetes, according to the new findings published in the Journal of General Internal Medicine.

For the study, researchers from Johns Hopkins University in Baltimore, Maryland, sent surveys to 1,000 primary care physicians who were randomly selected from the American Medical Association's Physician Masterfile, which includes data on more than 1.4 million physicians, residents, and medical students in the United States. Candidates for the survey included general practitioners who had completed residency training, general internists, and family physicians.

Survey questions evaluated a physician's knowledge of risk factors that should prompt prediabetes screening, laboratory criteria for diagnosing prediabetes, and recommendations for prediabetes management, practice behaviors regarding prediabetes management, and perceived barriers and potential interventions to improve prediabetes management.

For example, from a list of risk factor, PCPs were asked to select the ones that would lead them to order prediabetes screening for a patient. In another example, they were queried about their knowledge, understanding and use of prediabetes screening such as fasting blood glucose, two-hour oral glucose tolerance and hemoglobin A1c tests, all standard measures of blood sugar.

The researchers received 298 completed surveys, or 34 percent of the 888 ultimately found eligible for inclusion in the study. On average, respondents selected just 10 out of 15 correct risk factors for prediabetes, most often missing that African Americans and Native Americans are two groups at high risk. Only 42 percent of respondents chose the correct values of the fasting glucose and Hb1Ac tests that would identify prediabetes, while only 8 percent knew that a 7 percent weight loss is the minimum recommended by the American Diabetes Association as part of a diabetes prevention lifestyle change program.

Results also suggests that 25 percent of primary care doctors may be identifying people as having prediabetes when they have diabetes, which could lead to delays in getting those patients proper diabetes care and management.

These gaps may result from a healthcare education and reimbursement system that encourages doctors to prioritize treating diabetes once the disease occurs rather than working with patients to prevent it, according to Eva Tseng, MD, MPHS, assistant professor and lead author of the study.

Based on their findings, the researchers suggest strategies to address the provider knowledge gaps about prediabetes, as well as the system-level obstacles to preventing type 2 diabetes. These include better educating physicians about diabetes prevention, providing easier access for both physicians and their patients to national diabetes prevention lifestyle change programs, increasing insurance coverage of such programs, and offering new tools to help primary care providers improve the procedures and practices by which they diagnose and treat patients with prediabetes.

"We believe that what was learned from our survey can have implications for changing national guidelines and policies regarding type 2 diabetes prevention, including establishing measures of quality for diagnosing and managing prediabetes," Tseng said in a statement. "The public can help by advocating for more insurers to cover prevention programs, along with insisting that public health stakeholders expand access to and availability of these interventions."