Survey: Many Primary Care Physicians Are Unprepared to Help Patients Prevent Diabetes

The findings of a survey published by researchers from John Hopkins Medicine in the Journal of General Internal Medicine (JGIM) reveal significant gaps in primary care physicians (PCPs) overall knowledge of risk factors, diagnostic criteria and recommended management and prevention of prediabetes.

In this study, researchers sent surveys to 1,000 PCPs selected from the American Medical Association’s Physician Masterfile, comprised of data on more than 1.4 million physicians, residents and medical students in the United States. Candidates for the survey included general practitioners who had completed residency training, general internists and family physicians. The questions assessed physician’s knowledge of risk factors that should prompt prediabetes screening, laboratory criteria for diagnosing prediabetes, and recommendations for prediabetes management, practice behaviors regarding prediabetes management, as well as perceived barriers and potential interventions to improve prediabetes management.

For example, PCPs were prompted to select the ones that would lead them to order prediabetes screening for a patient. Also, they were queried about their knowledge, understanding and use of prediabetes screening such as fasting blood glucose, two-hour oral glucose tolerance and hemoglobin A1c (HbA1c) tests – which represent standard measures of blood sugar.

The researchers received 298 completed surveys, or 34% of the 888 ultimately found eligible for inclusion in the study. According to the study results, on average, respondents selected just 10 out of 15 correct risk factors for prediabetes, most often missing that African Americans and Native Americans are two groups at high risk. The researchers also observed that only 42% of respondents chose the correct values of the fasting glucose and Hb1Ac tests that would identify prediabetes. Moreover, only 8% knew that a 7% weight loss is the minimum recommended by the American Diabetes Association as part of a diabetes prevention lifestyle change program.

A Systemic Problem

“Our results revealed that there are substantial gaps in the knowledge that PCPs have in all three categories we tested,” said Eva Tseng, M.D., M.P.H., an assistant professor of general internal medicine at the Johns Hopkins University School of Medicine and lead author of the JGIM paper in a press release. Dr. Tseng continued by saying that the 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.”

“Along with closing the PCP knowledge gaps our survey identified, we believe the problem needs to be addressed at the health care system level,” says Nisa Maruthur, M.D., M.H.S., a Johns Hopkins associate professor of medicine and a co-author of the JGIM paper. “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.”