Patterns of Diabetes Screening and Prediabetes Treatment during Office Visits in the US

Abstract

Introduction: The American Diabetes Association recommends annual screenings for prediabetes if the patient meets the suggested requirements. The overall prevalence of prediabetes has decreased from an estimated 86 million adults in 2012 to 84.1 million adults in 2015 in the United States. Along with lifestyle modifications, the use of metformin as a treatment option or in combination has shown a decrease in weight and health care costs. This study was designed to review the prevalence of screening and treatment of prediabetes in the United States by using the National Ambulatory Medical Care Survey, as well as identify any factors associated with screenings and treatment. Methods: The National Ambulatory Medical Care Survey was used to examine a study sample of office visits between 2012 and 2015, reviewing the prevalence of screenings and lab services ordered or provided at each patient visit. Inclusion criteria consisted of the recommendations given by the American Diabetes Association including any patient >45 years or adult patient <45 years with a body mass index of >25 kg/m 2 and an additional risk factor. Patients with a previous diagnosis of diabetes were excluded from the sample. Results: A total of 105,721 office visits (2012 to 2015) were included in the analysis. The diabetes screening prevalence increased from 10% in 2012 to 13.4% in 2015. Metformin (n ‫؍‬ 140, 76.1%) was the most common antidiabetic medication prescribed to treat prediabetes. Conclusions: The prevalence of diabetes screening during office visits remained lower than 15% between 2012 and 2015 in the United States. Physicians primarily prescribe lifestyle modifications, including a healthy diet and exercise, with metformin being used in some cases for the prevention of diabetes.

Factors Associated with Clinician Adherence to USPSTF Diabetes Screening Recommendations

“…In prior studies, health insurance, specifically private insurance coverage, 5 , 6 was associated with diabetes screening, but this was not seen in our study as the rate of screening was not significantly different for patients without insurance. Interestingly, we did find an increased rate of screening for patients with Medicare or Medicaid.…”

“… 4 Studies have consistently found higher rates of screening in patients with female sex, older age, higher body mass index, non-white race, comorbidities such as hypertension or dyslipidemia, and regular medical health care. 4 - 6 One study on the impact of insurance showed that insured patients were more likely to receive screening. 5 Another study found that patients with private insurance were more likely to receive screening compared to patients with public insurance who were less likely to receive screening.…”

“… 5 Another study found that patients with private insurance were more likely to receive screening compared to patients with public insurance who were less likely to receive screening. 6 …”

Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA: NHANES (2013–2018)

“…Open access adoption of implementing pre-diabetes treatment guidelines in clinical practice is lacking. [9][10][11][12] When comparing those who know they have pre-diabetes to those with normal fasting serum glucose, those with pre-diabetes were more likely to report positive behavioural change such as weight control, increased exercise and fat and caloric reduction. 13 Yet less than 25% of patients with prediabetes reported having received lifestyle change advice during an office visit with their medical providers.…”

Ethnic and Racial Differences in Adoption of Evidence-based Diabetes Prevention Strategies and Weight Loss Outcomes in a Shared Decision-Making Intervention

“…Recent data demonstrate that the incidence and prevalence of prediabetes is rising among US non-Hispanic Blacks and Hispanics. 1,2 While not all patients with prediabetes will develop type 2 diabetes, diabetes prevalence is projected to increase almost threefold by 2060, with non-Hispanic Black women having the highest rates of increase. 3 Rates of diabetes related complications, including major amputations, are also higher among Hispanic and non-Hispanic Black patients as compared to White patients.…”