‘I could have made those changes years earlier’: experiences and characteristics associated with receiving a prediabetes diagnosis among individuals recently diagnosed with type 2 diabetes

Abstract

Background Prediabetes increases the risk of developing type 2 diabetes (T2D). Improving diet quality is key in preventing this progression, yet little is known about the characteristics of individuals with prediabetes or the nutrition care they receive. Objectives This study aims to identify characteristics and experiences associated with receiving a prediabetes diagnosis prior to developing T2D. Methods A mixed methods study encompassed a quantitative subanalysis of participants with newly diagnosed T2D from The 3D Study, and semi-structured telephone interviews with a subsample of participants who were previously diagnosed with prediabetes. Interviews were thematically analysed and survey data synthesized using SPSS statistical software. Results Of the 225 study participants, 100 individuals were previously diagnosed with prediabetes and 120 participants were not. Those with prediabetes were less likely to be smokers (P = 0.022) and more likely to be satisfied with seeing a dietitian (P = 0.031) than those without a previous prediabetes diagnosis. A total of 20 participants completed semi-structured interviews. Thematic analysis revealed three themes: (i) experiencing a prediabetes diagnosis; (ii) receiving nutrition care during prediabetes and (iii) reflecting on the experience of receiving care for prediabetes versus T2D. Conclusions There are gaps in the current management of prediabetes in Australia. Low rates of prediabetes diagnosis and an ambiguous experience of receiving this diagnosis suggest an area of health service improvement. With no difference in diet quality between individuals with and without a previous prediabetes diagnosis, the nutrition care during prediabetes may be more important than the diagnosis itself in delaying the onset of T2D.

How do healthcare providers support people with prediabetes to eat well? An in-depth, mixed-methods case study of provider practices

“…12 There were few associations between patient characteristics and the likelihood of their prediabetes being identified, suggesting non-patient factors may be more predictive of prediabetes identification and management. 12 A key non-patient related factor associated with prediabetes management may include how general practitioners (GPs) identify and manage prediabetes. When surveyed, GPs note the importance of nutrition in the chronic disease management of patients.…”

“…25 Patients have previously reported receiving limited, 'vague' or inconsistent dietary advice following a prediabetes diagnosis. 12 The current study shed light on why this might be, with HCPs stating that competing priorities and limited time made it difficult to discuss diet at every appointment. Time constraints in GP visits are frequently cited as barriers to providing nutrition care.…”

“…11 In the 3D Study of a nationally representative sample of Australian adults with newly diagnosed T2D, fewer than half the participants reported being told they had prediabetes prior to a diagnosis of T2D. 12 There were few associations between patient characteristics and the likelihood of their prediabetes being identified, suggesting non-patient factors may be more predictive of prediabetes identification and management. 12 A key non-patient related factor associated with prediabetes management may include how general practitioners (GPs) identify and manage prediabetes.…”

“…When surveyed, GPs note the importance of nutrition in the chronic disease management of patients. 13,14 However, patients report receiving limited nutrition care for prediabetes, 12,15 making it unclear to what extent nutrition care is actually provided in practice. The views and attitudes of HCPs who provide this support must be considered when developing effective strategies.…”

Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study

“…It is possible that individuals who did not make meaningful diet quality change during this period previously made changes when diagnosed with pre-diabetes. However, another analysis of the 3D study sample showed there were no differences in diet quality at baseline between those diagnosed with pre-diabetes and those who had not received a pre-diabetes diagnosis 25 . Another possibility is that some participants made changes immediately after receiving a diagnosis but before completing the baseline survey of the 3D study.…”