CMHC Pulse Blog

According to data from the Centers for Disease Control and Prevention, approximately 84 million adults  in the United States currently have prediabetes – and this number continues to rise. It is estimated that nearly 90% of individuals suffering from prediabetes are unaware of their condition, putting them at a high risk of type 2 diabetes development, heart disease, and other serious cardiometabolic complications. Both patients and physicians should know and understand the various risk factors contributing to prediabetes and type 2 diabetes to help mitigate the progression of the condition as well as its comorbidities.

However, despite nationwide policies supporting and promoting type 2 diabetes prevention efforts, little is known about type 2 diabetes prevention within the primary care setting – which is often the first point of contact for many individuals seeking care. According to new research published in the Journal of General Internal Medicine, up to 25% of physicians misdiagnose diabetic patients with prediabetes. On average, primary care physicians (PCPs) were unaware of up to 33% of risk factors for prediabetes and were unfamiliar with prevention protocols, management techniques, and even overall screening methods. 

 National Survey of Physician’s Prediabetes Knowledge

These gaps in physician education contribute many cases of under-screening and missed diagnoses of prediabetes, as well as a lack of referral of at-risk patients to type 2 diabetes prevention programs, according to Johns Hopkins University researcher and study author Eva Tseng, MD. In the recent study, Dr. Tseng and her colleagues assessed PCP’s overall knowledge and practice of potential interventions for improving the management of prediabetes <> as well as the perceived barriers to these efforts.

The team designed a cross-sectional, mailed survey to measure physician’s knowledge, practice behaviors, and perceptions of prediabetes. The study cohort was comprised of a nationally representative random sample of primary care physicians in the United States identified from the American Medical Association Physician Masterfile. Researchers performed chi-square and Fisher’s exact tests in order to evaluate the association between PCP characteristics and main survey outcomes.

Significant Gaps in Knowledge

Dr. Tseng and her team’s study revealed that PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes. Out of nearly 300 physicians, the researchers found that only 42% knew the correct value for fasting glucose and Hb1Ac tests – both measures which could properly diagnose prediabetes. Only 36% of physicians reported referring patients to diabetes prevention lifestyle change programs as their initial management approach, while up to 43% reported discussing starting metformin for prediabetes.

On average, physicians could identify 10 out of 15 risk factors for prediabetes and missed two of the most high-risk groups – African American and Native American demographics. Furthermore, only about 8% of participants was aware that promoting the loss of 7% of a patient’s body weight could reduce the risk of developing diabetes. The survey results also revealed that physicians believe that barriers to type 2 diabetes prevention exist both at an individual and systematic level, which could benefit from increased access to and improved insurance coverage of type 2 diabetes prevention programs.

“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,” Dr. Tseng wrote in a press release. “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.” 

Dr. Tseng’s latest findings highlight the urgent need to fix gaps in physician’s knowledge by providing improved diabetes prevention training as well as improving insurance coverage to help diagnose, treat, and manage patients with prediabetes to improve health outcomes. Current deficits in preventative education and training need to be addressed, while system-level changes are necessary to support prevention efforts within the primary care setting. Improving the diagnosis and management of patients with prediabetes can have a widespread beneficial impact on population health.


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