Identifying, treating prediabetes is key to healthier nation
One in three adult patients has prediabetes and 90 percent don’t even know it. But as a physician, you have an increasing number of tools to help prevent those patients from developing the disease. And that, in turn, has the potential to slow the rapidly growing epidemic of type 2 diabetes in the U.S.
Among the 84 million people who have prediabetes, 15 to 30 percent will develop type 2 diabetes in the next five years. If nothing is done to reverse this trend, statistics show that a typical large clinical practice could see a 32 percent increase in the number of patients that have diabetes. This is a major challenge for most physicians’ practices because people with diabetes are 100 percent more likely to develop hypertension, 80 percent more likely to be hospitalized for a heart attack, 50 percent more likely to be hospitalized for a stroke and 70 percent more likely to die from heart disease or a stroke.
“As a family physician, I find this absolutely overwhelming and the American Medical Association believes this is untenable for our practices,” said Kate Kirley, MD, director of chronic disease prevention at the AMA, during a recent AMA webinar titled, “Diabetes Care Begins with Diabetes Prevention.”
The discussion focused on how physicians can play a larger role in helping reverse the trend by identifying patients with prediabetes in their practice and helping them find the resources they need to manage their condition.
Timely action means 58% lower risk
To put this into practice, physicians first need to create awareness, said Janet Williams, senior program manager of physician and health system engagement at the AMA. Posters, literature and an entire tool kit to help physicians get started are available at Prevent Diabetes STAT.
Next, physicians need to identify patients with prediabetes, document the diagnosis and educate at-risk patients. Older adults want to be told they have a condition because they are more likely to do something about it when it is put that way instead of, for example, just being told they need to lose weight, Williams said.
“Let them hear they have a condition, but at the same time let them hear that it can be treated and reversed,” she added.
Once someone is identified, it is key to refer patients to an evidence-based intervention. One such evidence-based intervention is the National Diabetes Prevention Program (NDPP), which the Centers for Disease Control and Prevention (CDC) launched in 2012.
Studies have shown that patients with prediabetes who participate in the structured lifestyle-change program lower their risk of developing type 2 diabetes by 58 percent. That means among 100 high-risk adults who complete the program, three years later there will be 15 fewer cases of diabetes, eight fewer patients using anti-hypertensive medication and four fewer using anti-lipid medication.
“It is hard to think of anything we do in medicine that is this effective,” Dr. Kirley said. She noted that the government has documented that when a Medicare patient participates in NDPP, the government healthcare program saves $2,650 for that patient’s care after 15 months.
Here’s how the lifestyle-change program works: Participants attend weekly sessions led by a trained lifestyle coach for the first six months; they attend monthly maintenance sessions the second six months. During the program, patients are encouraged to reach a goal of 150 minutes of physical activity every week—even something as simple as walking around the block or gardening. They are taught about healthy eating, stress management and behavior modification. The goal is to lose at least 5 percent of their body weight in six months and then maintain the weight for six months.
Any health care system or community-based organization can implement the NDPP. The YMCA of the USA runs the largest in-person program in the nation, while one physician practice trained the practice’s receptionist to be a lifestyle coach. The CDC maintains a list of all recognized organizations with programs.
After referring a patient for help, physician practices need to follow up on patient progress. For example, check glucose levels in six to twelve months and ask the diabetes prevention program provider to let the practice know if the patients enrolled declined or dropped out. The program provider should already be sending progress updates on weight loss and attendance.
Diabetes prevention also was the focus of a recent expert panel discussion held in the AMA’s Reinventing Medical Practice Community.
To learn more about prediabetes and other steps you can take to help, check out a free module on preventing Type 2 diabetes in the AMA’s STEPS Forward™ collection of practice improvement strategies. The module is approved for AMA PRA Category 1 Credit™. The AMA also offers a more extensive education resources, tools and CME courses through its online Education Center.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks. The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.