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Not all PCPs realize CDC has tools to help prevent diabetes

Slightly more than one-third of primary care providers knew of the CDC-recognized lifestyle change program for preventing diabetes, and less than 20% knew of the agency’s STAT toolkit that serves the same purpose, according to findings recently published in the American Journal of Preventive Medicine.

“The Community Preventive Services Task Force and the U.S. Preventive Services Task Force issued recommendations for clinicians, specifying screening and testing guidelines, and suggesting that all patients with laboratory results in the prediabetes range be referred to an evidence-based type 2 diabetes prevention program to reduce type 2 diabetes risk and improve cardiometabolic risk factors,” Kunthea Nhim, DrPH, MPH, division of diabetes translation at the CDC, and colleagues wrote.

“This evidence led the AMA to partner with CDC to launch the Prevent Diabetes STAT initiative in 2015 aimed at increasing awareness of the National [Diabetes Prevention Program],” they added.

Researchers reviewed responses from 1,256 PCPs who completed the 2016 DocStyles survey. Besides awareness of the CDC-recognized lifestyle change program and STAT, researchers examined responses to prediabetes screening and testing frequency. Their findings included:

• 38% were aware of the CDC-recognized lifestyle change program;
• 19% were aware of the STAT toolkit;
• 97% ordered recommended blood tests;
• 27% screened patients for prediabetes by utilizing a risk test; and
• 23% made referrals.

Nhim and colleagues also found that PCPs who used electronic health records were more likely to screen, test and refer, and PCPs who knew of the lifestyle change program and the STAT toolkit were more likely to screen and refer patients.

“This study highlights the importance of increasing PCP awareness of and referrals to the CDC-recognized [lifestyle change program]. As the nation continues to expand its efforts toward type 2 diabetes prevention, PCPs will be called on to play an ever-growing critical role in prediabetes screening and testing, and referral to the CDC-recognized [lifestyle change program],” Nhim and colleagues concluded.

Kim Pfotenhauer

The study’s findings show that PCPs are conducting blood sugar screenings, but may be missing opportunities to improve patient care, according to Kim Pfotenhauer, DO, assistant professor of primary care at Touro University in California, who was not involved in Nhim et al’s study, but has previously reviewed American Diabetes Association guidelines in her own research and for Healio Family Medicine.

“The important take home message of this article is that 97% of primary care physicians are testing for prediabetes. Although lower numbers are using the screening tools described, I am not sure that it is necessary in the office setting as long as the testing is being done. These screening tools are often better suited to the community that may not present to the office for care. However, now that the National Diabetes Prevention Program is a covered benefit by Medicare, each time a patient with prediabetes is not referred is a missed opportunity for a covered benefit with proven efficacy,” Pfotenhauer said.

“There are many barriers to connecting patients with CDC-recognized programs including cost, lack of local programs or patients' reluctance to commit to the intensive year-long program. However, these programs have shown greater efficacy than medication in preventing type 2 diabetes. As we start to see an increase in the number of National Diabetes Prevention Programs available and an increase in the number of insurance companies paying for this benefit, I feel we will see an improvement in the number of patients being referred and taking advantage of these programs,” she continued.

Pfotenhauer added that referrals are not needed to take part in the National Diabetes Prevention Program. CDC’s website allows one to enter a zip code to find a CDC-recognized program near them, if a PCP does not offer the program him or herself. – by Janel Miller

Disclosure: None of the study's authors report any relevant financial disclosures. Healio Family Medicine was unable to determine Pfotenhauer’s relevant financial disclosures prior to publication.