Friday, November 18, 2016

U.S. Doctors Don’t All Follow Prediabetes Screening Guidelines

Only about half of U.S. family doctors follow guidelines on screening patients for prediabetes, a new study finds.

More than one-third of American adults have prediabetes, and most don’t know it. Prediabetes means that that blood sugar levels are higher than normal but not high enough to be diabetes. Diagnosing and treating prediabetes can prevent patients from developing diabetes, a leading cause of death in the United States.

University of Florida researchers surveyed more than 1,200 family doctors in academic medical settings nationwide. They found that those doctors with a positive attitude toward prediabetes as a clinical condition were more likely to follow national screening guidelines and offer treatment for their patients. Prediabetes treatments include medicine, exercise and losing weight.

Other doctors were more likely to suggest their patients make general lifestyle changes that may reduce heart disease risk, but aren’t associated with lowering blood sugar levels. Doctors also cited patients’ ability to make lifestyle changes, stay motivated and economic resources as significant barriers to preventing diabetes.

The study was published Nov. 8 in the Journal of the American Board of Family Medicine.

“Some physicians think that a prediabetes diagnosis ‘overmedicalizes’ patients, and some believe it is best to focus on providing general advice on healthy lifestyle,” study author Arch Mainous III said in a university news release. Mainous is chairman of health services research, management and policy in the College of Public Health and Health Professions.

The American Diabetes Association recommends prediabetes screening for adults who are overweight or obese and after age 45. The U.S. Preventive Services Task Force recommends screening for people between 40 and 70 years of age who are overweight or obese.

“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.

My Take:
On July 1, 2015, after a six month review process, the American Diabetes Association published their guidelines for prediabetes screening. They are supposed to be the standard of care. The most important aspect of these new guidelines was switching from the fasting glucose to the hemoglobin A1c as the gold standard for diagnosis of prediabetes and diabetes. Up until that time, the A1c was used to monitor previously diagnosed cases of diabetes only.

Clinically, I have been using the hemoglobin A1c to diagnose and treat both diabetes and prediabetes for the last six years. I believe the new guidelines are a step in the right direction, but don’t go far enough.

By the time Americans have reached the age of 40 and are overweight or obese, they have had prediabetes for several years. Clinically, I find the A1c begins to creep up above medical norms for many of my patients in their late 20’s to early 30’s, long before the guidelines kick in.

The Bottom Line:
I recommend every adult have their hemoglobin A1c run annually as a part of their preventive checkup. The sooner you catch prediabetes, the easier it is to correct. Don’t think that just because you are at your ideal weight, eat well, and exercise regularly that you are immune to diabetes. These things are vital to prevention but don’t rule out the disease.

Source: November 8, 2016 National Institutes of Health

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