Awareness of imminent diabetes diagnosis fails to change patients’ behavior
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Adults who were aware of their prediabetes status were more likely than those who were unaware to report a perceived risk for diabetes, data show.
However, the risk awareness was not associated with a meaningful difference in dietary or physical activity behaviors, according to researchers.
Erica Li, MD, a family medicine specialist at Jefferson University Hospitals in Philadelphia, and colleagues conducted a secondary analysis of 2015 to 2016 National Health and Nutrition Examination Survey data. The survey assessed participants’ personal risk for developing diabetes, general health status, understanding of their weight and desire to lose weight.
From nearly 10,000 responders, the researchers’ final analysis included 389 participants who were previously told they had prediabetes and 410 participants who were never told they had prediabetes but had a HbA1c that was “borderline” for diabetes (between 5.7% and 6.4%). The groups were propensity-score matched based on BMI, HbA1c level, race and education. There were 21 responders who were unmatched, and their data were not included in measured analysis.
According to Li and colleagues, 275 of those in the prediabetes-aware group said they felt they were at risk for diabetes compared with 97 in the prediabetes-unaware group. Statistically significant differences between the prediabetes-aware vs. prediabetes-unaware cohorts, respectively, included:
- number of participants who saw themselves as overweight (284 vs. 200), about the right weight (108 vs. 166) and underweight (17 vs. 22);
- number of participants who wanted to weigh more than their current weight (23 vs. 31), stay about the same weight (79 vs. 117) and weigh less than current weight (308 vs. 240);
- number of minutes typically spent doing moderate activity daily (55.6 vs. 80.45) and vigorous activity daily (73.94 vs. 95.64); and
- number of minutes typically spent sitting daily (389.26 vs. 353.8).
“We found that patients who were aware of their prediabetes diagnosis were more likely to report being at risk for developing diabetes and were more likely to see themselves as overweight,” Li told Healio Primary Care. “However, those who were aware of their prediabetes status were not more likely to engage in healthier dietary or physical activity behaviors compared to those who were unaware.”
Li and colleagues wrote in the Journal of the American Board of Family Medicine that a 2016 national survey that appeared in Diabetes Care indicated some primary care providers felt use of the term “prediabetes” may lead to overdiagnosis and overtreatment, while another 2016 study in the same journal found use of the term provided patients with an incentive to participate in preventive behaviors. According to Li, the “controversial” nature of the term “prediabetes” keeps many PCPs from discussing the condition with patients. She encouraged her peers to facilitate, not discourage, prediabetes discussions.
“It is important to talk with patients about what prediabetes is, what it means about the risk of developing diabetes in the future, and how to manage it,” she said. “Emphasize that prediabetes can be treated and adopting a healthier lifestyle will have many benefits, including preventing diabetes.”
Li added that referring patients with prediabetes to the National Diabetes Prevention Program and discussing, recognizing and finding solutions to barriers to making lifestyle changes could help more patients take steps to prevent diabetes.
Perspective
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I am not surprised by the findings of this study. It is a lot of work for patients to change their ways, especially for something they never wanted in the first place. Providers are busy and we tend to provide patients who are prediabetic multiple recommendations on what they should be doing. The patient may feel overwhelmed and lose hope of success.
To help patients avoid developing diabetes, start by asking what he or she knows about prediabetes and diabetes. You can learn about their understanding and may surface potential obstacles. Then conduct motivational interviewing with your patients. They may already know what can be done; if not you can offer a menu of options. Remember, this technique is about patients setting goals they think they can do, not what you — the health care professional — thinks they need to do.
With each item on this menu, ask the patient on a scale of one to 10 how likely they are to follow. If the patient’s response is seven or lower, it likely will not be followed. You may need to explore why their rating is not lower or urge them to start small. For example, if they are not doing any physical activity at all, have them start by walking to the mailbox each day. Then slowly, over time, they can increase the distance walked. You may also want to refer patients to a chronic disease self-management program and/or an online support group, which are good sources for learning how to avoid or live with diabetes.
The best way to achieve success is to take one step at a time. Once success in that step is reached, it breeds hope and more successes are likely to follow.
Clinical professor, Stanford University School of Medicine
President of the Board of Directors, Life Care Humboldt
Perspective
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Despite the increase in knowledge about diabetes, the rate of prediabetes and diabetes is increasing across the United States and around the world. You see it in the news, you see it online, you see lots of articles and people discussing diabetes as a pandemic itself.
I see a number of patients with prediabetes coming in for an appointment who ask, “what do I need to change?” My initial visit with a patient involves a lot of education about the process of diabetes and how diet and exercise influence the outcomes of diabetes. The information obtained can be overwhelming, but the education also allows someone to understand that the process of diabetes is not unifocal. Despite the information provided at visits, patients do not always make the lifestyle changes that would prevent the addition of more medications/treatments for their diabetes. Many people try fad diets (keto, whole 30, etc.) instead of the true lifestyle changes required to change the course of their disease. The entire process of managing diabetes can be discouraging given the effort put in on the provider’s side.
All that said, I would encourage other physicians to not get discouraged with the results of the study by Li and colleagues. Since the amount of time most PCPs have with patients is limited, referring a patient to a diabetes educator or a nutritionist can help improve diabetes control. Educators have more time available to spend with patients than providers. If this is not feasible, ask a member of your nursing staff to reach out to the patient, perhaps monthly, to ask if anything has changed and provide recommendations. Besides making recommendations, physicians and nurses may want to advise their patients that if they do not change their lifestyle, high BP, high cholesterol and heart disease could be down the road.
In the end, explaining health conditions and treatments alone will not ensure someone makes the appropriate changes to ensure health. Our job as providers is to educate our patients so they understand the medical consequences of not changing their habits. When the time comes, and patients are ready to change, they will look to their health care provider for direction.
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