Friday, July 28, 2017

Many Primary Care Docs May Miss Prediabetes

Most primary care doctors can’t identify all 11 risk factors for prediabetes, a small new survey finds.

Researchers for Johns Hopkins University said their finding should prompt doctors to learn more about this condition that affects an estimated 86 million adults in the United States and could eventually lead to type 2 diabetes.

“We think the findings are a wake-up call for all primary care providers to better recognize the risk factors for prediabetes, which is a major health issue,” said study first author Dr. Eva Tseng in a university news release. She’s an assistant professor at Hopkins’ School of Medicine.

It’s estimated that 90% of those with prediabetes are unaware that they have the condition, according to the U.S. Centers for Disease Control and Prevention.

The American Diabetes Association (ADA) explains that changes in diet, exercise and certain medications can help prevent people with prediabetes from going on to develop type 2 diabetes.

To investigate why so many people with prediabetes go undiagnosed, the researchers asked primary care doctors attending a medical retreat to complete a survey testing their knowledge of key risk factors for the condition.

The ADA has guidelines that list a total of 11 specific risk factors that determine if a patient should be screened for prediabetes. They include physical inactivity, a first degree relative with diabetes, high blood pressure, and a history of heart disease.

A total of 140 doctors took the survey. Nearly one-third of those surveyed weren’t even familiar with the ADA’s prediabetes guidelines. Only 6% were able to identify all 11 risk factors. On average, the doctors could correctly identify just eight of the warning signs.

Only 17% identified the correct values for fasting glucose and another key measure of glucose, known as HbA1c, which are used to diagnose prediabetes, the study authors said.

Most of the doctors said they wouldn’t prescribe metformin for prediabetes. But in 2017, the ADA recommended that metformin be considered for patients with prediabetes who haven’t reduced their risk for diabetes through lifestyle changes alone.

The results were published recently in the Journal of General Internal Medicine.

My Take:

The premise of preventative medicine is to identify and address all aspects of metabolic syndrome. Insulin resistance or prediabetes is typically the last and most serious of these aspects.

I have been contending that primary care physicians aren’t looking soon enough – the HbA1c is not recommended until age 40-45 and only if the patient is obese. Clinically, I see patients becoming prediabetic in their late 20s, often before most of the specific risk factors are evident.

However, this study suggests most PCPs aren’t even looking. Even worse many of them don’t know what to look for.

I strongly disagree with prescribing metformin in prediabetes. This disturbing trend has started to show up in my practice as well. In each case, no attempt was made to change the patient’s lifestyle. They just wrote them a script and doomed the patient to become a full-blown diabetic. With just a little effort and some nutritional supplementation, we have able to reverse the prediabetes in those early cases.

The Bottom Line:
Go to and take the risk test. Then present your results to your PCP and a good nutritionist. One or both of these practitioners should be able to help you develop a plan to improve your lifestyle. Insist on having the HbA1c run as a part of your yearly lab testing. Please, refuse the diabetic medication, metformin, if you are diagnosed with prediabetes.

Source: July 25, 2017 National Institutes of Health

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