Over one third of American adults are at high risk for developing diabetes, which can be delayed or prevented using interventions such as medical nutrition therapy (MNT) or metformin. Physicians’ self-reported rates of prediabetes treatment are improving, but patterns of actual referral, prescription, and MNT visits are unknown.
To characterize treatment of prediabetes in primary care.
We conducted a retrospective cohort study using electronic health record data. We described patterns of treatment and used multivariable logistic regression to evaluate the association of patient factors and PCP-specific treatment rate with patient treatment.
We included overweight or obese outpatients who had a first prediabetes-range hemoglobin A1c (HbA1c) during 2011–2018 and had primary care provider (PCP) follow-up within a year.
We collected patient characteristics and the following treatments: metformin prescription; referral to MNT, diabetes education, endocrinology, or bariatric medicine; and MNT visit. We did not capture within-visit physician counseling.
Of 16,713 outpatients with prediabetes, 20.4% received treatment, including metformin prescriptions (7.8%) and MNT referrals (11.3%), but only 7.4% of referred patients completed a MNT visit. The strongest predictor of treatment was the patient’s PCP’s treatment rate. Some PCPs never treated prediabetes, but two treated more than half of their patients; 62% had no patients complete a MNT visit. Being younger or female and having higher body mass index or HbA1c were also positively associated with treatment. Compared to white patients, black patients were more likely to receive MNT referral and less likely to receive metformin.
Almost 80% of patients with new prediabetes never received treatment, and those who did receive referrals had very poor visit completion. Treatment rates appear to reflect provider rather than patient preferences.
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Conflict of Interest
Dr. Misra-Hebert has received grant research support from the Agency for Healthcare Research and Quality K08 HS024128, grants from NHLBI, grants from Novo Nordisk, Inc, grants from Merck Inc, grants from Boehringer Ingelheim Pharmaceuticals, Inc, outside the submitted work. The other authors have no conflicts of interest to disclose.
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Speaker, S.L., Rastogi, R., Sussman, T.A. et al. Treatment of Patients with Prediabetes in a Primary Care Setting 2011–2018: an Observational Study. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06354-4