Doctors in a recent survey were unable to identify risk factors and patient engagement prevention strategies for diabetes.
Doctors might not have the tools to help drive patient engagement in preventing and detecting chronic illness, according to researchers from Johns Hopkins Medicine.
In a survey of about 1,000 primary care providers, the researchers found that clinicians struggled to correctly identify key diabetes risk factors, diagnostic criteria, and care management and preventive care strategies. These findings are likely the result of a culture of reactive, not proactive, healthcare that pervades medical education and the healthcare industry.
And ultimately, this culture could have disastrous effects for patients.
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“Our survey findings suggest that these gaps contribute to doctors underscreening for and missing diagnoses of prediabetes, and in turn, not referring patients to type 2 diabetes prevention programs,” said Eva Tseng, MD, MPH, an assistant professor of general internal medicine at the Johns Hopkins University School of Medicine and lead author of a paper published in the Journal of General Internal Medicine.
Nearly 84 million US adults have prediabetes, or the condition in which blood sugar levels are higher than normal but not high enough to qualify as diabetes. Although prediabetes is common throughout the US, nearly 90 percent of patients don’t know they have it. They rely on their doctors for that, the researchers suggested.
Clinicians who can diagnose prediabetes early on can engage their patients and coach them through certain lifestyle changes that could reverse the course of a possible chronic illness. Additionally, certain preventive measures could delay the development of heart disease, stroke, kidney failure, or nerve damage.
But when clinicians don’t know the risk factors for prediabetes or about the different preventive strategies that could stymie the development of diabetes, their patients may suffer. After completing surveys about prediabetes risk factors, diagnostic criteria, and prevention and care management strategies, the researchers found that a significant portion of providers may struggle.
From a list of various clinical risk factors, clinicians could identify only 10 of the 15 that related to prediabetes. Significantly, clinicians missed that patients of African American or Native American descent are at higher risk for diabetes.
Fewer than half, or 42 percent of respondents, correctly selected the fasting glucose and HbA1c testing levels that could indicate prediabetes. Only 8 percent of clinicians knew that a 7 percent weight loss meets the standard protocol from the American Diabetes Association for diabetes prevention.
“Our results revealed that there are substantial gaps in the knowledge that PCPs have in all three categories we tested,” Tseng said.
These results could limit providers’ ability to adequately diagnose patients who may have prediabetes and get them on a plan to slow or even prevent the disease’s course. Additionally, the findings could indicate that providers are not always identifying patients who have full type 2 diabetes.
“Our results also suggests that 25% of PCPs may be identifying people as having prediabetes when they actually have diabetes, which could lead to delays in getting those patients proper diabetes care and management,” explained Nisa Maruthur, MD, MHS, a Johns Hopkins associate professor and one of the study’s co-authors.
The researchers said these findings have broad implications and could point to a needed overhaul in medical education. Providers may need more access to national diabetes prevention guidelines to better target their patients and understand diabetes risk factors. Improving insurance coverage for diabetes and boosting patient access to preventive care could also make a difference.
“Along with closing the PCP knowledge gaps our survey identified, we believe the problem needs to be addressed at the health care system level,” Maruthur added. “This includes concerted efforts to make both health care providers and patients more aware of available type 2 diabetes prevention programs, encouraging patient enrollment in these programs, and getting insurance companies to understand their value and cover the costs.”
The medical industry may also reconsider care quality guidelines in diabetes diagnosing and prevention, the research team suggested.
“We believe that what was learned from our survey can have implications for changing national guidelines and policies regarding type 2 diabetes prevention, including establishing measures of quality for diagnosing and managing prediabetes,” Tseng concluded. “The public can help by advocating for more insurers to cover prevention programs, along with insisting that public health stakeholders expand access to and availability of these interventions.”
Date: September 20, 2019
Source: Patient Engagement Hit