Prediabetes: Resources for Providers

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Adult talking with their doctor

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. Most people don't know they have prediabetes, or that it's a serious health condition.

The good news is that health care providers like you can change that. The words and advice of trusted health care provider can have a significant impact when it comes to a patient taking action. When you help patients understand the negative health outcomes associated with prediabetes, recommend healthy habits, and refer those at risk to a proven Centers for Disease Control and Prevention (CDC)-recognized lifestyle change program, you give patients the tools to prevent type 2 diabetes.

How You Can Help

Here are some ways providers, like you, can help patients who are at risk for prediabetes.


Close up of hands folded on stomach

Identify at-risk patients

Patients can have prediabetes for years without displaying symptoms. That's why it is important to encourage patients who exhibit one or more risk factors to take the one-minute risk test.They can include having a history of diabetes in their family or other risk factors like having had gestational diabetes and being overweight or physically inactive.

 

Having this conversation may be difficult, especially if a patient has been dealing with trauma, shame, and stigma around their weight. Fat shaming is a very real byproduct of societal stigma around weight – one that we often do not take under consideration in public health work (Puhl & Heuer, 2012). These negative attitudes even invade medical facilities, leading to patients being turned away for care or have very real medical conditions needing treatment 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, including leading to increased weight (Tomiyama, et al., 2018). We must work to find ways to discuss weight that are culturally competent, kind, and compassionate.

Many tools utilized in measuring, monitoring, and curbing obesity may not be as effective for evaluating weight for a variety of people. For example, BMI was developed and tested on white cisgender men. It has not been updated in most cases to fit the needs of those among communities made up of additional races, ethnicities, genders, sexes, and more (Dougherty, Golden, Gross, Colantuoni, & Dean, 2020; WHO Expert Consultation, 2004 (PDF); Harvard T.H. Chan School of Public Health, 2021). It is important to acknowledge this history in order to 1) properly measure and interview patients versus relying on one number, 2) further recognize the ways inequity operates within public health and medicine, and 3) work towards building trust within communities harmed by exclusion and oppression.

This does not mean that we cannot still utilize BMI or similar methods – in fact, many spaces across healthcare, public health, and the National Diabetes Prevention Program continue to use BMI. We must recall that BMI is but one tool to fight obesity in a larger toolbox and that, as with the items in any toolbox, not every tool will fit every need. Take time to discuss a patient’s whole health when assessing risk.

  • Assess all of the risk factors.
  • Determine if the BMI is 25 or over.
  • Determine whether a diagnostic test has been run within the last year.

Doctor talking with patient

Talk to patients about a screening test

If you're treating a patient with a higher risk for prediabetes, it may be time to screen them for higher than normal blood sugar. Look for test results in the following prediabetes ranges:

  • Hemoglobin A1C of 5.7-6.4%, and/or
  • Fasting plasma glucose of 100-125mg/dL, and/or
  • Two-hour plasma glucose (after a 75-gram glucose load) of 140-199 mg/dL
 

Adult walking

Help patients make lifestyle changes

Start by talking with your patients about their environment, experiences, and other daily factors that may impact their opportunities for health. That includes helping 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). Shows that glorify dieting do not show the long-term struggles those who undergo massive weight loss face, including keeping off weight, being unable to sustain their extreme diets and/or exercise routines, etc.

 

Based on your patients' situation, help them connect with tools and resources that will work for them, including a CDC-recognized lifestyle change program in their community. Patients are more likely to join and succeed when their provider listens and recommends a program that considers all of their social determinants of health. Criteria for these programs include:  

  • Need to be 18 years old or older, plus
  • Most recent BMI of 25 or over, plus
  • A positive diagnostic test result with the previous 12 months, or
  • History of Gestational Diabetes Mellitus, or
  • High-risk result on prediabetes risk test, plus
  • Not pregnant and no previous diagnosis of type 1 or type 2 diabetes

Adult drinking water from a bottle

Keep Following Up With Patients

Make conversations about their diagnosis, blood sugar health, and lifestyle choices a regular conversation. Their long-term relationship with you will help sustain their success long after they reverse prediabetes or complete the program.

  • Use a motivational interviewing approach, including being nonjudgmental about weight and BMI.
  • Encourage them to start small and set realistic goals for better nutrition, increased physical activity, and reducing stress.
  • Provide patient-focused toolkits like the CDC's On Your Way to Preventing Type 2 Diabetes (PDF) for guidance in between appointments.
  • Help patients find a lifestyle change program that fits their specific needs.
 

Resources

Resources for providers, including American Medical Association (AMA) materials:

The National Diabetes Prevention Program

Treating Prediabetes and Preventing Diabetes in Your Clinic

Tobacco Cessation

Prediabetes and Health Equity

General
COVID-19
Race and Ethnicity
Gender and Sexuality
Comorbidities in Forcibly Marginalized Populations
Trauma, Discrimination, and Links to Diabetes
Weight Stigma

More Ways to Help Your Patients

As a provider, you can help your patients learn the facts about prediabetes, how they can take steps to prevent or reverse their condition, and gain access to additional resources. 

Last Revised: March 3, 2022