Participate in American Diabetes Month by Implementing Screening Guidelines for Prediabetes
It’s estimated that one-third of adults have prediabetes and don’t know it, so what better way to participate in American Diabetes Month this November than by reaching out with prediabetes education and screening? Your effort is especially important because many primary care physicians don’t assess for prediabetes, which means those patients don’t have the opportunity to make lifestyle changes that could prevent progression to full-blown diabetes. It only takes a few minutes to complete a quick prediabetes screening quiz, yet the results are significant, as your patients could lead to a life free from type 2 diabetes.
Current Issues Related to Prediabetes Screening
In March 2016, the Journal of the American Board of Family Medicine reported a review of data from the 2012 National Ambulatory Medical Care Survey. The researchers studied more than 11 million physician visits by adults aged 45 and older who were not diagnosed with diabetes, but who were tested within 90 days of the visit. Test results showed that nearly 34 percent were prediabetic—but 75 percent of them were not given a treatment plan.1
When University of Florida researchers surveyed more than 1,200 family doctors, they found that only half of them follow the recommended prediabetes screening guidelines.2 Many of the physicians don’t screen for prediabetes because they believe it over-medicalizes patients. They prefer to encourage a healthy lifestyle and weight loss without addressing blood sugar.
At least one group has raised concern over the online prediabetes screening tool—a short, seven-question quiz—that’s endorsed by the Centers for Disease Control and Prevention, the American Diabetes Association, and the American Medical Association. In October 2016, researchers from Tufts Medical Center published research indicating that the quiz may create too many false positives, as it would classify 73 million people as prediabetic.3 While that sounds high, it actually falls below the CDC’s estimate that 86 million Americans may be prediabetic.4 The American Diabetes Association noted that the free online screening is meant to identify people at risk while missing as few people as possible.
Screening Guidelines for Prediabetes
In spite of the concerns expressed by the Tufts study, the seven questions on the online quiz accurately reflect key risk factors for prediabetes. The American Diabetes Association (ADA) established standards of medical care that recommend the following prediabetes screening guidelines for asymptomatic adults:5
Age – Age is a major risk factor, so diabetes testing should begin at age 45 for all patients regardless of weight. If tests are negative, they should be repeated every three years.
Weight and Other Risk factors – Diabetes testing should be considered for any adult who is overweight (BMI of 25 and over) and has one or more of the additional risk factors:
- Physical inactivity
- First-degree relative with diabetes
- High-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
- Women who delivered a baby weighing greater than 9 pounds
- Women diagnosed with gestational diabetes
- High cholesterol and/or triglyceride levels
- Women with polycystic ovary syndrome
- Previous A1C test of 5.7 percent or higher
- History of cardiovascular disease
Most of the recommendations have a grade B recommendation, which means that they’re supported by evidence from well-conducted cohort studies. While not backed by studies, the expert consensus recommends testing for prediabetes in children and adolescents who are overweight or obese and who have two or more additional risk factors.
Pharmacist Outreach During American Diabetes Month
You have plenty of opportunities to counsel patients who are already diagnosed with diabetes when they pick up prescriptions, so for American Diabetes Month, take a unique slant and fill the screening gap by boosting awareness about prediabetes. Dedicate a portion of the front end of your pharmacy to diabetes products, especially those that would appeal to patients who may not know they have prediabetes, such as skin care lotions and low-carb snacks and beverages.
Be sure to provide handouts with basic information about prediabetes.6 You could put up a display where patients can get a printed version of the prediabetes screening tool or set up a laptop computer where they can take the online quiz.7 Set aside specific times when you or a diabetes educator are available to answer questions. Here’s some of the most important information to include:
- Diabetes basics – Patients may not understand what causes prediabetes and diabetes. More importantly, they need to learn about the long-term health risks when the disease goes untreated. Sometimes hearing the hard-core facts—the increased risks associated with diabetes like heart disease, neuropathy, and diabetic retinopathy—helps motivate patients to make lifestyle changes.
- Talk about weight management – Being overweight is a primary risk factor for prediabetes, so the topic can’t be ignored. When 1,109 overweight or obese adults were surveyed, only 35 percent reported that their physician talked with them about weight loss.8 In other words, patients desperately need straight talk about weight management and the role of medications and lifestyle changes.
- Lifestyle changes – acknowledge that lifestyle changes are hard and require dedication to healthy long-term habits, including changing dietary habits, increasing exercise and smoking cessation. Refer patients to registered dietitians, diabetes education programs or other local programs that support weight loss and patients with diabetes.
- Body mass index – Some of your patients may not be familiar with using the body mass index to assess their weight status, so explain the concept and refer them to an online calculator.9
- Explain diabetes tests – These may be any one of the following: fasting plasma glucose, 2-hour plasma glucose after a 75-gram oral glucose tolerance test, or A1C levels.
Prediabetes Education and Screening Helps Promote Long-Term Health
Patients aren’t being adequately screened for prediabetes, which puts them at risk for type 2 diabetes, heart disease and other chronic diseases. Pharmacists who offer prediabetes education and screening—during November and on a regular basis throughout the year—fill a vital role in the community. Your efforts can help fill the information and screening gap, alert patients about their window of opportunity to prevent type 2 diabetes, and offer them hope for a healthier future.
Pharmaeutica North America provides prescription drug products, bulk and unit-dose active pharmaceutical ingredients, and OTC topical solutions and dietary supplements that support the health of patients with diabetes. Contact us today to talk about how we can support your pharmaceutical needs.
- “Prediabetes Diagnosis and Treatment in Primary Care,” March 2016, http://www.jabfm.org/content/29/2/283.long ↩
- “U.S. Doctors Don’t All Follow Prediabetes Screening Guidelines: Study,” November 2016, https://medlineplus.gov/news/fullstory_161906.html ↩
- “Prediabetes Risk in Adult Americans According to a Risk Test,” October 2016, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2560373 ↩
- “CDC: Prediabetes,” August 2016, http://www.cdc.gov/diabetes/basics/prediabetes.html ↩
- “American Diabetes Association: Standards of Medical Care in Diabetes – 2016,” January 2016, http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf ↩
- “Prediabetes: Could It Be You?” accessed November 2016, http://www.cdc.gov/diabetes/pubs/statsreport14/prediabetes-infographic.pdf ↩
- “CDC Prediabetes Screening Test,” accessed November 2016, https://www.cdc.gov/diabetes/prevention/pdf/prediabetestest.pdf ↩
- “Disparities in Who Receives Weight-Loss Advice From a Health Care Provider: Does Income Make a Difference?” October 2016, http://www.cdc.gov/pcd/issues/2016/16_0183.htm ↩
- “Calculate Your Body Mass Index,” accessed November 2016, https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm ↩