Introduction: Prediabetes, affecting over a third of American adults, represents a critical stage for intervention to prevent or delay the onset of type 2 diabetes. Effective strategies like medical nutrition therapy (MNT) and metformin are available, yet the actual implementation of prediabetes diagnosis and treatment in primary care settings remains significantly underutilized, raising serious concerns.
Study Overview: A comprehensive retrospective study analyzed electronic health records from 2011 to 2018, focusing on over 16,000 overweight or obese outpatients newly diagnosed with prediabetes. The research aimed to characterize the real-world patterns of prediabetes treatment within primary care.
Key Findings: The study revealed a stark reality: almost 80% of patients with a new prediabetes diagnosis received no treatment whatsoever. Specifically, metformin prescriptions were issued to a mere 7.8%, while referrals to Medical Nutrition Therapy (MNT) were slightly higher at 11.3%. However, the completion rate of MNT visits was extremely low, with only 7.4% of referred patients actually attending a session. Interestingly, a primary predictor of whether a patient received treatment was their primary care provider’s (PCP) pre-existing treatment patterns. This suggests that provider behavior, rather than solely patient characteristics, significantly influences treatment decisions. Younger age, female gender, higher BMI, and elevated HbA1c levels were associated with increased likelihood of receiving treatment. Racial disparities were also evident, with Black patients being more likely to receive MNT referrals but less likely to be prescribed metformin compared to white patients.
MNT Completion Challenge: The alarmingly low rate of MNT visit completion underscores a significant hurdle in effectively managing prediabetes. Simply referring patients to MNT is insufficient; strategies are needed to improve patient engagement and adherence to these crucial preventative programs.
Conclusion: This study highlights a substantial and concerning treatment gap in prediabetes management within primary care. Improving prediabetes diagnosis and treatment in primary care necessitates interventions targeted at provider-level practices and focused efforts to enhance patient engagement in lifestyle modification programs like MNT. Addressing these systemic and behavioral barriers is crucial to effectively prevent the progression from prediabetes to type 2 diabetes and mitigate the associated health risks.
