American Medical News
By — Posted April 8, 2013
Educating patients with elevated blood glucose levels about their increased risk of developing type 2 diabetes could help physicians motivate them to make lasting lifestyle changes that improve their health and well-being, said an expert at the Centers for Disease Control and Prevention.
The problem, however, is that far too few U.S. adults are aware of their risk, said Ann Albright, PhD, RD, director of the Division of Diabetes Translation at the CDC.
Having “such low awareness about a condition that you can do something about” is concerning, said Albright, who co-wrote a study on prediabetes awareness in the March 22 issue of the CDC’s Morbidity and Mortality Weekly Report.
The study shows that in 2010, one in three adults age 20 and older (an estimated 79 million people) had prediabetes. In that condition, a person’s blood sugar level is higher than normal but is not high enough for a diabetes diagnosis, the CDC said.
Of those adults with prediabetes, only 11% were aware that they had the condition. Although that figure marks a slight improvement from 2005-06, when 7% of people reported knowing they had prediabetes, awareness of the condition is too low, researchers said.
People with prediabetes are more likely to develop type 2 diabetes than those without the condition, according to the American Diabetes Assn. If action is taken early, however, risk of type 2 diabetes can be significantly reduced by losing weight and exercising moderately, the ADA said.
The MMWR study shows “that we are not raising the visibility of diabetes, in particular, prediabetes, to the level that we need to,” Albright said.
A key step for physicians is testing patients for elevated blood glucose levels, the ADA said. The organization recommends that doctors test for prediabetes among people who are overweight and age 45 or older.
For younger patients who are overweight, physicians should base the decision to screen on other diabetes risk factors, including family history of the disease, hypertension and belonging to an ethnic or minority group at high risk of diabetes.
When a patient is diagnosed with prediabetes, physicians face an assortment of challenges in addressing the problem, Albright said. Those challenges include a lack of time, discomfort discussing the sensitive issue of weight and difficulty getting patients to make long-term lifestyle changes, she said.
For those reasons, the CDC encourages doctors to refer patients with prediabetes to an evidence-based intervention program that is led by trained instructors and intends to reduce the individual’s risk of developing type 2 diabetes by increasing physical activity, improving diet and achieving moderate weight loss.
Among the benefits of these programs are that patients can interact with other people who have prediabetes. Another asset is that the trained instructors, unlike many primary care doctors, have time to teach patients about actionable steps they can take to improve their health, Albright said.
“It’s not just ‘Eat less. Move more. Good luck,’ ” she said.
An estimated 25.8 million U.S. children and adults (8.3% of the population) have diabetes, according to the ADA. As many as one in three adults could have diabetes by 2050 if current trends continue, the CDC said.
For the MMWR study, researchers examined data from three sampling cycles of the National Health and Nutrition Examination Survey. Those cycles were 2005-06, 2007-08 and 2009-10.
They identified 2,603 adults age 20 and older with prediabetes. Those individuals had a fasting plasma glucose test result of 100-125 mg/dL or a hemoglobin A1c level of 5.7% to 6.4%.
Participants were asked if a doctor ever had told them they have prediabetes, borderline diabetes, impaired fasting glucose, impaired glucose tolerance or a blood glucose level that is higher than normal but not high enough to be called diabetes. The prevalence of prediabetes awareness was compared across selected sociodemographic characteristics, including age, race/ethnicity and education level, health care access or use and other factors.
Researchers found that during 2005-10, awareness of prediabetes was low (below 14%) across all population subgroups. Prevalence of prediabetes awareness was lowest among people age 20 to 44 (5.1%), compared with individuals 45 to 64 (10%) and those 65 and older (11.9%).
“Because the vast majority of persons with prediabetes are unaware of their condition, identification and improved awareness of prediabetes are critical first steps to encourage those with [the condition] to make healthy lifestyle changes or to enroll in evidence-based, lifestyle-change programs aimed at preventing type 2 diabetes,” the study authors wrote.
When prediabetes does progress to type 2 diabetes, physicians need to watch their adult patients closely for signs of depression and be sure that those diagnosed with the mental health condition understand how to properly take their medications, said a separate study published online March 20 in the Journal of General Internal Medicine.
Depression occurs twice as frequently in adults with diabetes compared with adults who don’t have diabetes, the study said.
“It’s a serious comorbidity that doctors increasingly are having on their radar” when caring for patients with diabetes, said senior study author Andrew J. Karter, PhD. He is a research scientist at Kaiser Permanente Northern California in Oakland, Calif.
Researchers examined data on 1,366 adults age 30 to 75 with type 2 diabetes who participated in the Diabetes Study of Northern California between 2005 and 2006. The participants were members of Kaiser Permanente Northern California and were newly prescribed an antidepressant. The study examined medication nonadherence in the 12 months after the initial antidepressant was prescribed. Participants were considered adherent if they picked up and refilled their prescriptions.
Researchers found that 72% of participants had limited health literacy and significantly poorer adherence to newly prescribed antidepressants than patients with no limitations. Patients with any health literacy limitations were significantly more likely to discontinue their medication before the first refill (46%) compared with participants who had no limitations (38%).
The high rates of early discontinuation among adults with health literacy issues suggest that few of those individuals received adequate depression treatment, said lead study author Amy M. Bauer, MD.
“Physicians should be aware of this,” said Dr. Bauer, an acting assistant professor in the Dept. of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. “For antidepressant treatment to succeed [among diabetics], patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up.”