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Addressing diabetes prevention in primary care

Professional factors such as workload and time constraints can pose obstacles in discussing diabetes prevention in primary care, according to findings recently published in PLOS One.

Other potential obstacles included various patient factors associated with diabetes prevention and the context and setting of diabetes progression.

Researchers suggested solutions to all three obstacles.

“Primary care can be a valuable setting for preventing diabetes in at-risk populations as patients can be offered support for prevention, such as screening and lifestyle advice, by primary care professionals such as [general practitioners], practice nurses or health care assistants,” Josie Messina, PhD student at University of Manchester’s School of Primary Care in the United Kingdom, and colleagues wrote. “Little is known about how health practitioners discuss lifestyle modifications with patients in primary care... Thus, there is a need for research to understand how lifestyle risk factors are addressed within primary care.”

Messina and colleagues performed a narrative system review combining qualitative and quantitative studies of type 2 diabetes prevention within a primary care setting for patients at-risk for diabetes. They searched various databases, including MEDLINE, Embase, Psych info, BNI, SSCI, CINAHL and ASSIA, using an iterative approach for evidence collection that combined diabetes terms with primary care terms.

Messina and colleagues identified three themes after analyzing 18 papers and 6,646 database records.

The first such theme, professional factors impacting diabetes prevention, included items such as workload, resources, self-efficacy, and the role of perceived patient motivation acting as a barrier or facilitator for lifestyle advice impacted care. Messina and colleagues suggested focusing on staff training and educational initiatives to foster health professional self-efficacy as well as streamlining preventative services to maximize efficiency to assist in tackling these issues.

According to researchers, the second theme — context and setting of diabetes progression — dealt in part with the fact that health professionals and patients understood the potential seriousness of Type 2 diabetes, not all the general practitioners knew that pre-diabetes could lead to diabetes. In addition, Messina and colleagues noted there was not an overall consensus on whether diabetes prevention should be addressed in primary care, and suggested “a more effective provision of knowledge could mitigate” this barrier.

Messina and colleagues noted that with the third theme, patient factors associated with diabetes prevention, that for some patients who did change their habits, a lack of time to exercise and prepare healthy meals was seen as an obstacle to maintaining these changes over the long term. For such patients, researchers suggested letting patients provide some input in developing plans “with realistic, sustainable, and achievable goals, as well as helping with motivation.”

“This review has identified various factors relevant to diabetes prevention in primary care, such as the importance of understanding diabetes risks by both providers and patients, as well as how patient motivations not only drive change but also have an impact on professionals offering advice,” Messina and colleagues wrote. “Further research is particularly needed on the setting of prevention, and the optimal provision of knowledge to both patients and professionals.” – by Savannah Demko

Disclosures: The researchers report no relevant financial disclosures.