Adults with prediabetes often don’t get much attention paid to their condition by primary care providers, and about 6% experience progression to diabetes within a year, according to a new study published in the Journal of General Internal Medicine.
Prediabetes is defined as elevated blood glucose that doesn’t meet the threshold for diabetes. That generally means a fasting blood glucose level of 100-125 mg/dl, or an A1C level (a measure of long-term blood glucose control) between 5.7% and 6.4%. While an estimated 88 million American adults have prediabetes, more than 80% of people with the condition don’t know they have it — since many doctors don’t routinely do blood glucose screening, and many people don’t routinely see a doctor. While experts disagree about how serious of a health problem prediabetes should be considered, the U.S. Preventive Services Task Force recently recommended lowering the screening age for prediabetes and type 2 diabetes to 35, from 40. While prediabetes is concerning in part because it often leads to diabetes, just having prediabetes may also raise the risk for certain health problems. Recent studies have found that having prediabetes is linked to a higher risk for major depression, as well as a higher risk for cognitive decline in middle-aged adults.
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For the latest study, researchers looked at data for 3,888 people with prediabetes (based on a laboratory test result) from 37 different primary care clinics. The average age of participants was 63, and 65% were female. When it came to race and ethnicity, 55% were white, 35% were Black, and 3% were Hispanic. About 50% were Medicare enrollees (traditional Medicare or Medicare Advantage), while 23% had commercial insurance and about 13% had a Medicaid plan. The average body-mass index at the start of the study was 30.0 — exactly at the starting point for obesity — and 40% of participants had a BMI of 30 or higher.
Low-rates of official diagnosis, follow-up care for prediabetes
The researchers found that while all of the participants in the study had a test result indicating prediabetes, only 13% actually had a coded diagnosis of prediabetes — making it likely that in at least some cases, doctors failed to recognize prediabetes or discuss it with patients. While follow-up blood glucose testing in some form was ordered for 63% of participants, only 1% got a referral to a nutrition counselor, and only about 5% got a prescription for metformin — the first-line type 2 diabetes drug that is gaining growing acceptance as a treatment for at least some higher-risk cases of prediabetes.
After a 12-month follow-up period, the researchers found that about 80% of participants had seen their health care provider again, and out of the 63% of participants who got further blood glucose testing ordered, 79% actually followed through with the lab test. Out of the 1% of participants who were referred to a nutritionist, about 76% attended such a visit. And out of the 5% of participants who were prescribed metformin, 76% filled the prescription. Overall, 6% of participants developed diabetes during the follow-up period — including about 4% of those with newly identified prediabetes a year earlier, and 7% of those whose prediabetes was already established a year earlier. Participants who developed diabetes were more likely than other participants to have another health care visit, follow through with blood glucose testing, or see a nutritionist during the follow-up period.
“Rates of prediabetes clinical care activities remain low, suggesting little has changed in practices around diabetes prevention,” the researchers concluded. “Strategies to improve prediabetes diagnosis, [Diabetes Prevention Program] and nutrition referrals, and metformin prescribing are urgently needed to improve prediabetes care delivery with the goal of preventing or delaying incident diabetes.”
Want to learn more about prediabetes? Read “What Is Prediabetes? Symptoms, Treatment, and More,” “Prediabetes Treatment” and “Diabetes Prevention: Eat to Beat Diabetes.”