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Dr. Greathouse
: Despite an abundance of evidence that diabetes can be prevented or delayed, many clinicians are failing to diagnose or treat patients with prediabetes.
Using data obtained from a nationally representative sample of the US population 3 years after publication of the Diabetes Prevention Program results (Fourth National Health and Nutrition Examination Survey [NHANES IV]), Karve and Hayward assessed the proportion of 1547 adults who met the criteria for impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and the proportion of adults with these conditions who (1) reported receiving a formal diagnosis from their physicians, (2) reported having lifestyle modification recommended or were prescribed an oral hypoglycemic agent, and (3) were actively modifying their lifestyle or taking an oral hypoglycemic agent.
Individuals were considered prediabetic if they reported that a physician told them had "borderline diabetes, prediabetes, impaired fasting glucose, or impaired glucose tolerance." Receipt of an anti-hyperglycemic agent was considered pharmacotherapy for prediabetes, and vigorous or moderate activity for about 30 minutes daily for the previous 30 days was considered "compliant" with American Diabetes Association recommendations for treatment of IFG/IGT. Participants were also asked whether their physicians recommended diet or exercise modification.
Only 3.4% of the study sample reported receiving a previous diagnosis of IFG, IGT, borderline diabetes, or prediabetes, but 584 persons (38%) had IFG or IGT (or both conditions). Of the persons who reported a diagnosis, 38.5% no longer met the criteria for prediabetes. No individuals diagnosed with prediabetes reported receiving oral anti-hyperglycemic medications. Of the 584 prediabetic individuals, 31.7% (95% confidence interval [CI], 23.3%-40.2%) reported receiving counseling for exercise, 33.4% (95% CI, 26.4%-40.5%) for diet, and 25.9% (95% CI, 17.9%-34.5%) for both. However, adherence to counseling was relatively high -- 86% of those who received a recommendation to control their diet or weight reported engaging in that behavior, and 70% of those who received an exercise recommendation reported exercising.
Viewpoint
Studies from around the world have firmly established that diabetes can be prevented or delayed with lifestyle modification or pharmaceutical interventions in patients with IFG/IGT.[1-4] Despite this abundance of evidence, the current study suggests that physicians in the United States are rarely diagnosing prediabetes.
Of course, considering patients' imperfect recall, coupled with the fact that what goes in the chart and what is discussed with the patient may not be identical, the diagnosis rates may not be as poor as reported in this study. Still, these findings show that fewer than one third of patients with prediabetes are given (or recall being given) advice on diet and exercise, and pharmacotherapy is rarely given. Thus, it is difficult to conclude anything other than that the results of well-publicized diabetes prevention trials are not being translated into clinical practice.
The news is not all bad. It is encouraging to see in the current findings that 70% to 86% of patients who received diet or exercise recommendations actually followed this advice. Given that success, however, the relatively low proportion of patients who received such counsel is all the more glaring.
We know that diabetes prevention is possible, and we now know that patients will attempt the necessary lifestyle changes. All we have to do is ask.
My apologies.
ReplyDeleteHere's the data.
Study Summary
Using data obtained from a nationally representative sample of the US population 3 years after publication of the Diabetes Prevention Program results (Fourth National Health and Nutrition Examination Survey [NHANES IV]), Karve and Hayward assessed the proportion of 1547 adults who met the criteria for impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and the proportion of adults with these conditions who (1) reported receiving a formal diagnosis from their physicians, (2) reported having lifestyle modification recommended or were prescribed an oral hypoglycemic agent, and (3) were actively modifying their lifestyle or taking an oral hypoglycemic agent.
Individuals were considered prediabetic if they reported that a physician told them had "borderline diabetes, prediabetes, impaired fasting glucose, or impaired glucose tolerance." Receipt of an anti-hyperglycemic agent was considered pharmacotherapy for prediabetes, and vigorous or moderate activity for about 30 minutes daily for the previous 30 days was considered "compliant" with American Diabetes Association recommendations for treatment of IFG/IGT. Participants were also asked whether their physicians recommended diet or exercise modification.
Only 3.4% of the study sample reported receiving a previous diagnosis of IFG, IGT, borderline diabetes, or prediabetes, but 584 persons (38%) had IFG or IGT (or both conditions). Of the persons who reported a diagnosis, 38.5% no longer met the criteria for prediabetes. No individuals diagnosed with prediabetes reported receiving oral anti-hyperglycemic medications. Of the 584 prediabetic individuals, 31.7% (95% confidence interval [CI], 23.3%-40.2%) reported receiving counseling for exercise, 33.4% (95% CI, 26.4%-40.5%) for diet, and 25.9% (95% CI, 17.9%-34.5%) for both. However, adherence to counseling was relatively high -- 86% of those who received a recommendation to control their diet or weight reported engaging in that behavior, and 70% of those who received an exercise recommendation reported exercising.
Viewpoint
Studies from around the world have firmly established that diabetes can be prevented or delayed with lifestyle modification or pharmaceutical interventions in patients with IFG/IGT.[1-4] Despite this abundance of evidence, the current study suggests that physicians in the United States are rarely diagnosing prediabetes.
Of course, considering patients' imperfect recall, coupled with the fact that what goes in the chart and what is discussed with the patient may not be identical, the diagnosis rates may not be as poor as reported in this study. Still, these findings show that fewer than one third of patients with prediabetes are given (or recall being given) advice on diet and exercise, and pharmacotherapy is rarely given. Thus, it is difficult to conclude anything other than that the results of well-publicized diabetes prevention trials are not being translated into clinical practice.
The news is not all bad. It is encouraging to see in the current findings that 70% to 86% of patients who received diet or exercise recommendations actually followed this advice. Given that success, however, the relatively low proportion of patients who received such counsel is all the more glaring.
We know that diabetes prevention is possible, and we now know that patients will attempt the necessary lifestyle changes. All we have to do is ask.