It’s likely that 1 in every 3 of your adult patients is at risk for prediabetes or on their way to developing type 2 diabetes. About 80% of those with prediabetes don’t even know they have it. Many also don’t know it’s a serious health condition.
The good news is that health care providers like you can change those statistics. The advice of trusted health care providers can have a significant impact. Your words can inspire a patient to take action.
By helping patients understand the negative health outcomes associated with prediabetes and recommending healthy lifestyle habits, you’re giving them knowledge and tools to help prevent type 2 diabetes. You can refer those at risk to a proven lifestyle change program recognized by the CDC (Centers for Disease Control and Prevention).
How to help your patients
Here are some ways providers like you can help patients who are at risk for prediabetes.
Patients can have prediabetes for years without showing any symptoms. That’s why it’s important to encourage patients who show one or more risk factors to take the 60-Second Type 2 Diabetes Risk Test by American Diabetes Association (ADA). One risk is having a family history of diabetes. Other risk factors include having had gestational diabetes, being overweight, or being physically inactive.
Having these conversations with patients aren’t always easy, especially if a patient has been dealing with trauma, shame, and stigma from being overweight. Fat shaming is a real byproduct of societal stigma, one that we often don’t take under consideration in public health work (Puhl & Heuer, 2012). Negative attitudes invade medical facilities. This leads to patients being turned away for care or needing treatment for medical conditions that are instead blamed on their weight (Udo, Purcell, & Grillo, 2016).
Unfortunately, that stigma likely increases the harm done when we approach discussions of weight and obesity from a clinical, one-size-fits-all standpoint. This approach could lead to increased weight (Tomiyama, et al., 2018). We must find ways to discuss weight that are culturally competent, kind, and compassionate.
Many tools used to measure, monitor, and curb obesity may not be effective for evaluating weight for some people. For example, body mass index (BMI) was developed and tested on white cisgender men. The index hasn’t been updated in most cases to fit the needs of communities of other races, ethnicities, genders, sexes, and more (Dougherty, et al., 2020; Mittal, et al., 2004; Harvard T.H. Chan School of Public Health, 2021). It’s important to acknowledge this history to:
- Properly measure and interview patients, versus relying simply on the patient’s BMI.
- Further recognize the ways inequity operates within public health and medicine.
- Build trust within communities harmed by exclusion and oppression.
This doesn’t mean we can’t use BMI or similar methods. In fact, many spaces across health care, public health, and the National Diabetes Prevention Program continue to use BMI. The key is to realize that BMI is just one tool to fight obesity. There are other tools in your toolbox. Remember that not every tool will fit every need. When assessing a patient’s risk, take time to discuss the patient’s whole health.
- Assess all the patient’s risk factors.
- Calculate if BMI is 25 or higher.
- Determine whether a diagnostic test has been run within the past year.
If you’re treating a patient who is at risk for prediabetes, consider screening them for higher than normal blood sugar. Look for test results in any one of the following prediabetes ranges:
- Hemoglobin A1C of 5.7-6.4%
- Fasting plasma glucose of 100-125mg/dL
- Two-hour plasma glucose (after a 75-gram glucose load) of 140-199 mg/dL
Start by talking with your patients about their environment, experiences, and other daily factors that impact their chances for good health. Help patients learn about and avoid harmful methods to lose weight. For example, many forms of dieting have been shown to lead to higher incidences of cardiovascular events and even death (Bangalore, et al., 2017).
Televised shows and online videos that glorify dieting often don’t show the long-term struggles faced by those who undergo massive weight loss. Challenges include keeping off the weight, as well as sustaining their extreme diets and/or exercise routines.
Based on each patient’s situation, help them connect with tools and resources that could work for them, including a CDC-recognized lifestyle change program. Patients are more likely to join with your encouragement. They’re more likely to succeed when their provider listens and recommends a program that considers all of their Social Determinants of Health.
Acceptance in most lifestyle change programs include all the following criteria:
- 18 years old or older
- Most recent BMI of 25 or higher
- A positive diagnostic test result with the previous 12 months, history of gestational diabetes mellitus, or high-risk result on the 60-Second Type 2 Diabetes Risk Test
- Not pregnant
- No previous diagnosis of type 1 or type 2 diabetes
Discuss the patient’s diagnosis, blood sugar health, and lifestyle choices at every visit. Their long-term relationship with you will help them sustain success long after they reverse prediabetes or complete the program.
- Use a motivational interview approach, including being nonjudgmental about weight and BMI.
- Encourage them to start small and set realistic goals for better nutrition, increased physical activity, and reduced stress.
- Provide patient-focused toolkits like the CDC’s On Your Way to Preventing Type 2 Diabetes (PDF) for guidance between appointments.
- Help patients find a lifestyle change program that fits their specific needs.
Prediabetes and health equity
- ADA—Health Equity Now
- ADA—Social Determinants of Health and Diabetes: A Scientific Review
- Association of Diabetes Care & Education Specialists—Understanding Bias in Your Profession: 3 Things You Can Do to Improve Care
- Nature Medicine—To Tackle Diabetes, Science and Health Systems Must Take into Account Social Context
- Research Gate—The Challenge of Cultural Differences in Diabetes Prevention
- Trust for America’s Health—State of Obesity 2021: Better Policies for a Healthier America
- American College of Physicians, Journals—Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study
- American Psychological Association—Stress in America: One Year Later, A New Wave of Pandemic Health Concerns (PDF)
- CDC—Obesity, Race/Ethnicity, and COVID-19
- HPM Global Learning Network—Impactful Research Shows How Health Equity, Diabetes, and COVID-19 Are Linked
- JAMA Network—Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study
- Springer Nature—COVID-19 Self-quarantine and Weight Gain Risk Factors in Adults
- Wiley Online Library—Impact of the COVID-19 Pandemic on Unhealthy Eating in Populations with Obesity
- ADA—Differences in A1C by Race and Ethnicity Among Patients With Impaired Glucose Tolerance in the Diabetes Prevention Program
- American Journal of Managed Care—Recognizing the Role of Systemic Racism in Diabetes Disparities
- American Journal of Preventive Medicine—Measuring Structural Racism and Its Association With BMI
- Canadian Medical Association Journal—“Hunger was never absent”: How Residential School Diets Shaped Current Patterns of Diabetes Among Indigenous Peoples in Canada
- CDC—Diabetes and Asian American People
- CDC—Hispanic or Latino People and Type 2 Diabetes
- Centers for Medicare & Medicaid Services—Racial and Ethnic Disparities in Diabetes Prevalence, Self-Management, and Health Outcomes among Medicare Beneficiaries (PDF)
- Endocrine Web—Deeply Rooted: An Endocrine Web Special Report on Race and Diabetes
- Harvard T.H. Chan School of Public Health—Ethnic Differences in BMI and Disease Risk
- National Institutes of Health (NIH), article from the World Health Organization—Appropriate Body-Mass Index for Asian Populations and Its Implications for Policy and Intervention Strategies (PDF)
- Oxford Academic—Social Determinants of American Indian Nutritional Health
- Pro Publica—The Black American Amputation Epidemic
- American Association for the Advancement of Science, EurekAlert—Transgender patients with diabetes may not be adequately treated for risk factors
- ADA—Providing Culturally Sensitive Diabetes Care and Education for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community
- CDC—Diabetes and Men
- CDC—Diabetes and Women
- NIH—Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review
- National LGBTQIA+ Health Education Center—Diabetes Prevention and Management for LGBTQ People (PDF)
- University of California San Francisco Transgender Care—Diabetes Mellitus and Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
- Brookings—Black and Hispanic Americans at higher risk of hypertension, diabetes, obesity: Time to fix our broken food system
- National LGBTQIA+ Health Education Center—Diabetes, Heart Disease, and LGBTQIA+ Populations
- National LGBTQIA+ Health Education Center—HIV and Diabetes
- National LGBTQIA+ Health Education Center—HIV and Diabetes Mellitus
- PLOS One—Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy
- ADA—Adverse Childhood Experiences and the Risk of Diabetes: Examining the Roles of Depressive Symptoms and Cardiometabolic Dysregulations in the Whitehall II Cohort Study
- JAMA Network—Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women: A 22-Year Longitudinal Study
- Oxford Academic—Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA)
- TIME—The Link Between Mental Trauma and Diabetes
- American Journal of Public Health—Obesity Stigma: Important Considerations for Public Health
- BMC Medicine—How and why weight stigma drives the obesity ‘epidemic’ and harms health
- NIH—Perceived Weight Discrimination and Chronic Medical Conditions in Adults with Overweight and Obesity
- National LGBTQIA+ Health Education Center—Why Weight? Improving the health of LGBTQIA+ patients by reducing weight stigma
- Wiley Online Library—The Stigma of Obesity: A Review and Update
Here are links to additional resources for providers, including materials from the American Medical Association (AMA).
- CDC—Benefits to Your Practice
- CDC—Details About the Program
- CDC—Diabetes Prevention Lifestyle Change Program (PDF)
- CDC—How Pharmacists Can Participate
- CDC—How to Talk to Your Patients about the Medicare DPP (PDF)
- CDC—Materials to Engage and Recruit Patients
- CDC—National Diabetes Prevention Program Customer Service Center
- CDC—PreventT2 Lifestyle Change Program (PDF)
- CDC—Program Eligibility
- CDC—Research Behind the National DPP
- CDC—Testimonials from providers and participants
- CDC—Why Refer to a CDC-Recognized Lifestyle Change Program?
- NIH—10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study
- ADA—Motivational Interviewing Improves Weight Loss in Women With Type 2 Diabetes
- American Medical Association—Diabetes prevention toolkit
- American Association of Family Physicians—Diabetes Self-Management: Facilitating Lifestyle Change
- Association of Diabetes Care & Education Specialist—Speaking the Language of Diabetes: Language Guidance for Diabetes-Related Research, Education and Publications (PDF)
- California Department of Public Health—Guide for Engaging Patients with Prediabetes to Improve Population Health (PDF)
- CDC advice to help your practice achieve patient-centered medical home (PCMH) recognition—M.A.P. (Measure, Act, Partner) (PDF) and meaningful use of your electronic medical record Promoting Interoperability from Health Information Technology. This supports PCMH recognition via Standard 4: Self-Care Support, B. Provide Referrals to Community Resources.
- NIH—Game Plan for Preventing Type 2 Diabetes
- NIH—How to Talk With Patients About Their Prediabetes Diagnosis
- NIH—Motivational Interviewing: Do’s and Don’ts
- NIH synthesizes areas of agreement among guidelines to help guide primary care providers and health care teams to deliver quality care—Guiding Principles for the Care of People With or at Risk for Diabetes
- National LGBTQIA+ Health Education Center—Motivational Interviewing to Improve Chronic Illness Management in Marginalized Populations
- Psychology Today—Motivational Interviewing
Other ways to help your patients
As a provider, you can help your patients learn the facts about prediabetes, teach them how to prevent or reverse their condition, and provide access to other resources.