The purpose of the study was to assess patient and clinician perceptions of prediabetes in an academic family medicine practice. Data were collected in preparation for an implementation study to increase utilization of the National Diabetes Prevention Program (N-DPP).
Methods
In this mixed-methods study, discussions from 3 focus groups composed of patients with prediabetes were evaluated using thematic analysis for their understanding of and beliefs about prediabetes, care experiences, and attitudes toward N-DPP. Clinicians completed a Likert-scaled survey assessing attitudes and perceived barriers to providing prediabetes care.
Results
Among the 15 focus group participants, more than half were not aware of their diagnosis. Attitudes toward prediabetes were mixed: while many believed it was serious and elicited more fear than being “at risk,” others thought there were varying degrees of risk within the same diagnosis, making the diagnosis less impactful. Patients repeatedly expressed the perception that clinicians were not forthcoming about necessary behavior changes. Patients agreed on barriers to N-DPP, including scheduling and transportation. Clinicians (N = 31) concurred that patients lack awareness of their prediabetes diagnosis. They reported that time is available to screen all patients and that a prediabetes diagnosis is effective for advising patients of the need for lifestyle modification. There was consensus from both patients and clinicians that prediabetes is curable.
Conclusions
Increased patient awareness and patient-centered education is needed to overcome barriers to prediabetes care. To facilitate implementation of N-DPP referral processes, clinicians should clearly communicate risk, treatment information, and linkage to N-DPP as the suggested treatment plan.
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References
1.
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017. https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed December 3, 2018.
2.
Centers for Disease Control and Prevention. Awareness of prediabetes—United States, 2005-2010. MMWR Morb Mortal Wkly Rep2013;62:209-212.
3.
TabákAGHerderCRathmannWBrunnerEJKivimäkiM. Prediabetes: a high-risk state for developing diabetes. Lancet. 2012;379(9833):2279-2290.
TuomilehtoJLindströmJErikssonJGet al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.
7.
KnowlerWCBarrett-ConnorEFowlerSEet al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
8.
KieferMMSilvermanJBYoungBANelsonKM. National patterns in diabetes screening: data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012. J Gen Intern Med. 2015;30(5):612-618.
9.
MehtaSMocarskiMWisniewskiTGillespieKNarayanKMVLangK. Primary care physicians’ utilization of type 2 diabetes screening guidelines and referrals to behavioral interventions: a survey-linked retrospective study. BMJ Open Diabetes Res Care. 2017;5(1):e000406.
10.
ChambersECWylie-RosettJBlankAEet al. Increasing referrals to a YMCA-based diabetes prevention program: effects of electronic referral system modification and provider education in federally qualified health centers. Prev Chronic Dis. 2015;12:E189.
11.
HafezDNelsonDBMartinEGCohenAJNorthwayRKullgrenJT. Understanding type 2 diabetes mellitus screening practices among primary care physicians: a qualitative chart-stimulated recall study. BMC Fam Pr. 2017;18(1):50.
12.
NhimKKhanTGrussSMet al. Primary care providers’ prediabetes screening, testing, and referral behaviors. Am J Prev Med. 2018;55(2):e39-e47.
WeilandTJNguyenMJelinekGA. Illness perception and knowledge with regard to prediabetes and type 2 diabetes: a pilot study of emergency department patients and staff. Eur J Emerg Med. 2012;19(6):353-358.
15.
DouglasFTorranceNvan TeijlingenEMeloniSKerrA. Primary care staff’s views and experiences related to routinely advising patients about physical activity: a questionnaire survey. BMC Public Health. 2006;6:138-138.
16.
ChanWVPearsonTABennettGCet al. ACC/AHA special report: clinical practice guideline implementation strategies: a summary of systematic reviews by the NHLBI Implementation Science Work Group: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Am Coll Cardiol. 2017;69(8):1076-1092.
17.
FosterGDWaddenTAMakrisAPet al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168-1177.
18.
SeehusenDADeaversJMainousAGLedfordCJW. The intersection of physician wellbeing and clinical application of diabetes guidelines. Patient Educ Couns. 2018;101(5):894-899.
19.
DalalMRGrabnerMBonineNStephensonJJDiGenioABieszkN. Are patients on basal insulin attaining glycemic targets? Characteristics and goal achievement of patients with type 2 diabetes mellitus treated with basal insulin and physician-perceived barriers to achieving glycemic targets. Diabetes Res Clin Pract. 2016;121:17-26.
20.
MessinaJCampbellSMorrisREylesESandersC. A narrative systematic review of factors affecting diabetes prevention in primary care settings. PLoS One. 2017;12(5):e0177699.
21.
WylieGHunginAPSNeelyJ. Impaired glucose tolerance: qualitative and quantitative study of general practitioners’ knowledge and perceptions. BMJ. 2002;324(7347):1190.
22.
GallivanJBrownCGreenbergRClarkCM. Predictors of perceived risk of the development of diabetes. Diabetes Spectrum. 2009;22(3):163-169.
23.
TroughtonJJarvisJSkinnerCRobertsonNKhuntiKDaviesM. Waiting for diabetes: perceptions of people with pre-diabetes: a qualitative study. Patient Educ Couns. 2008;72(1):88-93.
24.
O’BrienMJMoranMRTangJWet al. Patient perceptions about prediabetes and preferences for diabetes prevention. Diabetes Educ. 2016;42(6):667-677.
25.
O’BrienBCHarrisIBBeckmanTJReedDACookDA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245-1251.
26.
American Diabetes Association. Standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S1-S2.
27.
DaivadanamMAbsetzPSathishTet al. Lifestyle change in Kerala, India: needs assessment and planning for a community-based diabetes prevention trial. BMC Public Health. 2013;13(1):95.
28.
TsengEGreerRCO’RourkePet al. Survey of primary care providers’ knowledge of screening for, diagnosing and managing prediabetes. J Gen Intern Med. 2017;32(11):1172-1178.
29.
Fearn-SmithJDGEvansPHHardingGCampbellJL. Attitudes of GPs to the diagnosis and management of impaired glucose tolerance: the practitioners attitudes to hyperglycaemia (PAtH) questionnaire. Prim Care Diabetes. 2007;1(1):35-41.
30.
HelminkJHKremersSPvan BoekelLCvan Brussel-VisserFNde VriesNK. Factors determining the motivation of primary health care professionals to implement and continue the ‘Beweegkuur’ lifestyle intervention programme. J Eval Clin Pract. 2012;18(3):682-688.
31.
MainousAGIIITannerRJScuderiCBPorterMCarekPJ. Prediabetes screening and treatment in diabetes prevention: the impact of physician attitudes. J Am Board Fam Med. 2016;29(6):663-671.
32.
YudkinJSMontoriVM. The epidemic of pre-diabetes: the medicine and the politics. BMJ. 2014;349:g4485.
33.
RosalMCBenjaminEMPekowPSLemonSCvon GoelerD. Opportunities and challenges for diabetes prevention at two community health centers. Diabetes Care. 2008;31(2):247.
34.
FisherEBWalkerEABostromAFischhoffBHaire-JoshuDJohnsonSB. Behavioral science research in the prevention of diabetes: status and opportunities. Diabetes Care. 2002;25(3):599-606.
35.
EvansPHGreavesCWinderRFearn-SmithJCampbellJL. Development of an educational ‘toolkit’ for health professionals and their patients with prediabetes: the WAKEUP study (Ways of Addressing Knowledge Education and Understanding in Pre-diabetes). Diabet Med. 2007;24(7):770-777.
36.
GeissLSJamesCGreggEWAlbrightAWilliamsonDFCowieCC. Diabetes risk reduction behaviors among U.S. adults with prediabetes. Am J Prev Med. 2010;38(4):403-409.
37.
AliMKEchouffo-TcheuguiJWilliamsonDF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?Health Aff (Millwood). 2012;31(1):67-75.
38.
Mensa-WilmotYBowenSARutledgeSet al. Early results of states’ efforts to support, scale, and sustain the National Diabetes Prevention Program. Prev Chronic Dis. 2017;14:E130.
