Consciousness of imminent diabetes prognosis fails to alter sufferers’ habits

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February 23, 2021

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According to data, adults who were aware of their prediabetes status were more likely than those who were unaware of a perceived risk of diabetes.

However, according to researchers, risk awareness was not associated with a significant difference in diet or exercise behavior.

Erica Li, MD, A family medicine specialist at Jefferson University Hospitals in Philadelphia and colleagues performed a secondary analysis of data from the National Health and Nutrition Examination Survey from 2015 to 2016. The survey assessed participants’ personal risk for developing diabetes, overall health, understanding their weight, and wanting to lose weight.

Out of 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 HbA1c that was “borderline” for diabetes ( between 5.7% and 6.4%). The groups were compared on the basis of BMI, HbA1c level, race, and education with the propensity score. There were 21 responders who disagreed and their data were not included in the measured analysis.

According to Li and colleagues, 275 people in the prediabetes-conscious group said they were at risk for diabetes, compared with 97 in the prediabetes-deficient group. The statistically significant differences between the cohorts who are aware of prediabetes and the cohorts who are not aware of prediabetes included:

  • Number of participants who considered themselves overweight (284 vs. 200), roughly the correct weight (108 vs. 166), and underweight (17 vs. 22);
  • Number of participants who wanted to weigh more than their current weight (23 vs. 31), wanted approximately the same weight (79 vs. 117) and wanted to weigh less than their current weight (308 vs. 240);
  • Number of minutes normally spent daily with moderate activity (55.6 vs. 80.45) and daily intense activity (73.94 vs. 95.64); and
  • Number of minutes typically spent sitting down each day (389.26 versus 353.8).

“We found that patients who were aware of their prediabetes diagnosis were more likely to report being at risk of developing diabetes and more likely to consider themselves overweight,” Li told Healio Primary Care. “Those who are diagnosed with prediabetes Status, but showed no greater likelihood of healthier eating or physical activity than those who were not. “

Li and colleagues wrote in the Journal of the American Board of Family Medicine that a 2016 national survey published in Diabetes Care found that some primary care providers believed that using the term “prediabetes” could lead to overdiabetes and over-treatment , while another 2016 study in the same journal found that the use of the term provided an incentive for patients to engage in preventive behaviors. According to Li, the “controversial” nature of the term “prediabetes” prevents many PCPs from discussing the condition with patients. She encouraged her colleagues to facilitate, not discourage, prediabetes discussions.

“It’s important to talk to 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 that there are many benefits to a healthier lifestyle, including preventing diabetes.

Li added that referring patients with prediabetes to the National Diabetes Prevention Program and discussing, identifying, and finding solutions to lifestyle change barriers could help more patients take action to prevent diabetes.

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Ann Lindsay, MD)

Ann Lindsay, MD

I am not surprised by the results of this study. It is a lot of work for patients to change their behaviors, especially for something they didn’t want at all. Providers are busy and we tend to give multiple recommendations to patients who are prediabetic about what to do. The patient can feel overwhelmed and lose hope of success.

To help patients avoid diabetes, first ask what they know about prediabetes and diabetes. You can learn about their understanding and discover potential obstacles. Then conduct a motivational interview with your patient. You may already know what can be done; If not, you can offer a menu of options. Remember, this technique is about patients setting goals that they think they can, not what you – the doctor – think is necessary.

For each item on this menu, ask the patient how likely they are to follow on a scale of 1 to 10. If the patient’s response is seven or less, it is likely not being followed. You may need to figure out why their rating isn’t lower or ask them to start small. For example, if they don’t do any physical activity at all, let them go to the mailbox every day to begin with. Then you can slowly increase the distance covered over time. You may also want to refer patients to a chronic disease self-management program and / or online support group, which are good sources for learning how to avoid or live with diabetes.

The best way to have success is to take it step by step. Once success is achieved in this step, there is hope and more success is likely to follow.

Ann Lindsay, MD

Co-Director, Stanford Coordinated Care
Clinical Professor at Stanford University School of Medicine
Chairman of the Board of Directors, Life Care Humboldt

Disclosure: Lindsay does not report any relevant financial information.

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Richard J. Millstein, DO)

Richard J. Millstein, DO

Despite the increasing knowledge of diabetes, the rate of prediabetes and diabetes is increasing in the United States and around the world. You see it on the news, you see it online, you see a lot of articles and people discussing diabetes as a pandemic itself.

I see a number of prediabetes patients who come for an appointment and ask, “What do I need to change?” My first visit to a patient involves a lot of education about the process of diabetes and how diet and exercise affect the outcomes of diabetes. The information received can be overwhelming, but the education also enables someone to understand that the process of diabetes is ambiguous. Despite the information provided during visits, patients do not always make lifestyle changes that would prevent adding more medications / treatments for their diabetes. Many people try dieting (keto, full 30, etc.) in lieu of the actual lifestyle changes required to change the course of their illness. The entire process of treating diabetes can be daunting given the efforts of the provider.

Even so, I would encourage other doctors not to be discouraged by the results of Li and colleagues’ study. Because the time most PCPs spend with patients is limited, referring a patient to a diabetes professional or dietitian can help improve diabetes control. Educators have more time with patients than providers. If this is not possible, ask a member of your caregiver to reach out to the patient, possibly monthly, to ask if anything has changed and to make recommendations. In addition to providing recommendations to their patients, doctors and nurses want to point out that if they don’t change their lifestyle, high blood pressure, high cholesterol, and heart disease can all result.

In the end, explaining health conditions and treatments alone won’t ensure someone makes the appropriate changes to ensure health. Our job as a provider is to educate our patients so that they understand the medical consequences of not changing their habits. When the time comes and patients are ready to change, they will contact their doctor for instructions.

Richard J. Millstein, DO

Endocrinologist, UCHealth Diabetes and Endocrinology, Greeley, Colo.

Disclosure: Millstein does not report any relevant financial information.

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