Spring
2020

In my practice at The Polyclinic Endocrinology, I have attained a sizable population of patients with diabetes, spanning from Type 1 to 1.5 to 2. When I see these patients for the first time, I review with them the pathophysiology of the disease, and how prediabetes may often predate a diabetes diagnosis by 1, 5, or 10 years. Many patients wonder what they should have done differently or if their diabetes diagnosis could have been prevented.

Challenges in Patient Education

It is estimated that of the 84 million (1 out of 3) U.S. adults with prediabetes, 90% are unaware of their diagnosis. A recent 2019 Journal of the American Medical Association (JAMA) article delved into the barriers in identifying prediabetes as a diagnosis and areas of focus for preventing progression to diabetes. In this survey of 300 primary care physicians, up to 25% of patients who were determined to have prediabetes actually met criterion for diabetes. Of those determined to have prediabetes, 93% of physicians recommend diet and exercise as the first intervention to managing diabetes, yet only 36% of patients ever received referrals to a prediabetes class series or intensive lifestyle modification program. The reasons for this discrepancy are many and can be largely attributed to lack of basic resources for healthy food options and exercise, lack of insurance coverage for diabetes prevention programs, and technological barriers to flagging patients with abnormal labs and streamlining referral processes.

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It is important to recall the findings of the 2002 Diabetes Prevention Program (DPP) that examined the risk of progression of prediabetes to Type 2 diabetes. This study showed that lifestyle intervention (150 minutes of exercise weekly, dietary modification, and 7% weight loss) reduced diabetes onset by 58% and metformin by 31% compared to placebo/no intervention over a three-year period. Therefore, referral to a formalized prediabetes program with education and focus on these measures can be a key intervention in curbing the rising rate
of this disease.

Another recent 2019 article in JAMA Pediatrics examined the prevalence of prediabetes in adolescents and young adults. Of 3,180 young adults ages 19 to 34, the prevalence of prediabetes was 24% (the highest rate was among obese males). Intervening early with our prediabetic patients can help to make a significant impact on the disease trajectory.

Prevention (CDC) estimates, 9.9% of adult Washingtonians have diabetes. With increased attention to this condition and utilization of proven effective resources, we can help slow the progression of this disease in our population of patients. At The Polyclinic, we provide formal programs for both Prediabetes and Diabetes education, offering a flexible class schedule and availability for individualized appointments. Many insurance companies cover the cost of diabetes education, particularly in the first year of diagnosis. The Endocrinology Department also welcomes diabetes referrals for patients in need of additional assistance.

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Written By: Lori Cooper MD