Counseling for Prediabetes Should be Heightened in Primary Care

Prediabetes is a condition where an individual’s blood glucose is abnormally high, but not high enough to be called type 2 diabetes. But prediabetes raises the risk of type 2 diabetes. Because of the nature of prediabetes, a healthcare provider -- especially one in a primary care setting -- can collaborate with the patient to determine if there is a need to treat the condition. Being over 40 years of age, overweight or obese, for example, can raise the risk of type 2 diabetes in a patient with prediabetes. If the patient is at high risk of getting type 2 diabetes, the provider should counsel the patient or make a referral.

The provider should counsel the patient on ways to make lifestyle changes to treat the prediabetes, or refer the patient to an organization that can provide the counseling. While the referral rate for prediabetes treatment is unknown, counseling for prediabetes in a primary care setting is relatively low. The level of counseling for prediabetes should be increased.

Approximately 88 million adults in the US have prediabetes. And the CDC’s Diabetes Prevention Program study has shown that addressing prediabetes using intensive lifestyle intervention (ILI) can reduce the incidence of type 2 diabetes. Based on the results of the Diabetes Prevention Program  study, the CDC established the Diabetes Prevention Program (DPP) to help individuals treat prediabetes.

Counseling high risk patients with prediabetes or referring the patients to an organization that offers prediabetes counseling is recommended by the US preventive services task force (USPSTF) . However, one study showed that only about 40% of patients with prediabetes were counseled by a healthcare provider to control or lose weight, increase physical activity, or decrease the fat or calories in the diet.

The investigators further stated that “participants who were counseled to adopt healthy lifestyle reported high adherence to weight control and diet modification.” So while ILI, used by the DPP, can reduce type 2 diabetes cases by treating prediabetes, providers often don’t counsel patients who have the condition.

Since patients are more often in a primary care setting than any other healthcare setting, primary care providers can be an important factor in helping to decrease the number of type 2 diabetes cases by counseling patients who have prediabetes.

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