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.
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.
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
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
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 for providers, including American Medical Association (AMA) materials:
The National Diabetes Prevention Program
- Details About the National Diabetes Prevention Program
- Why Refer to the National Diabetes Prevention Program?
- Program Eligibility
- Benefits to Your Practice
- Testimonials from Providers and Participants
- Materials to Engage and Recruit Patients
- How Pharmacists Can Participate
- National Diabetes Prevention Program Customer Service Center
Treating Prediabetes and Preventing Diabetes in Your Clinic
- Diabetes Prevention Toolkit from the American Medical Association
- Diabetes Self-Management: Facilitating Lifestyle Change
- Following a M.A.P. to Diabetes Prevention for Your Practice (PDF) can help your practice achieve patient-centered medical home (PCMH) recognition, as well as meaningful use of your electronic medical record. It supports PCMH recognition via Standard 4: Self-Care Support, B. Provide Referrals to Community Resources.
- Game Plan for Preventing Type 2 Diabetes
- Guide for Engaging Patients with Prediabetes to Improve Population Health (PDF) – A guide from the California Department of Public Health on suggestions for engaging patients.
- Guidelines for Media Portrayals of Individuals Affected by Obesity (PDF) - While focused on media portrayals, this document helps readers keep in mind the stigma that can be conveyed through language around obesity and weight. The CDC encourages the use of person-first language (e.g., adults with obesity) when discussing topics like obesity and other chronic diseases, as well as respectful images.
- Guiding Principles for the Care of People With or at Risk for Diabetes – These Guiding Principles aim to identify and synthesize areas of general agreement among existing guidelines to help guide primary care providers and health care teams to deliver quality care to adults with or at risk for diabetes.
- How to Talk With Patients About Their Prediabetes Diagnosis
- Motivational Interviewing
- Motivational Interviewing: Do's and Don'ts
- Motivational Interviewing Improves Weight Loss in Women With Type 2 Diabetes
- Motivational Interviewing to Improve Chronic Illness Management in Marginalized Populations
- Speaking the Language of Diabetes Language Guidance for Diabetes-Related Research, Education and Publications (PDF)
Prediabetes and Health Equity
- ADA: Health Equity Now
- State of Obesity 2021: Better Policies for a Healthier America
- Social Determinants of Health and Diabetes
- The Challenge of Cultural Differences in Diabetes Prevention
- To Tackle Diabetes, Science and Health Systems Must Take Into Account Social Context
- Understanding Bias in Your Profession: 3 Things You Can Do to Improve Care
- Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study
- COVID-19 Self-quarantine and Weight Gain Risk Factors in Adults
- Impact of the COVID-19 Pandemic on Unhealthy Eating in Populations with Obesity
- Impactful Research Shows How Health Equity, Diabetes, and COVID-19 Are Linked
- Obesity, Race/Ethnicity, and COVID-19
- Stress in America: One Year Later, A New Wave of Pandemic Health Concerns (PDF)
- Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study
Race and Ethnicity
- Appropriate Body-Mass Index for Asian Populations and Its Implications for Policy and Intervention Strategies (PDF)
- Deeply Rooted: An Endocrine Web Special Report on Race and Diabetes
- Diabetes and Asian Americans
- Differences in A1C by Race and Ethnicity Among Patients With Impaired Glucose Tolerance in the Diabetes Prevention Program
- Ethnic Differences in BMI and Disease Risk
- Hispanic/Latino Americans and Type 2 Diabetes
- “Hunger was never absent”: How Residential School Diets Shaped Current Patterns of Diabetes Among Indigenous Peoples in Canada
- Measuring Structural Racism and Its Association With BMI
- Racial and Ethnic Disparities in Diabetes Prevalence, Self-Management, and Health Outcomes among Medicare Beneficiaries (PDF)
- Recognizing the Role of Systemic Racism in Diabetes Disparities
- Social Determinants of American Indian Nutritional Health
- The Black American Amputation Epidemic
Gender and Sexuality
- Diabetes and Men
- Diabetes and Women
- Diabetes Mellitus from Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
- Diabetes Prevention and Management for LGBTQ People (PDF)
- Effects of Gender-Affirming Hormone Therapy on Insulin Resistance and Body Composition in Transgender Individuals: A Systematic Review
- Providing Culturally Sensitive Diabetes Care and Education for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community
- Transgender Patients With Diabetes May Not Be Adequately Treated for Risk Factors
Comorbidities in Forcibly Marginalized Populations
- Black and Hispanic Americans at higher risk of hypertension, diabetes, obesity: Time to fix our broken food system
- Diabetes, Heart Disease, and LGBTQIA+ Populations
- HIV and Diabetes
- HIV and Diabetes Mellitus (PDF)
- Incidence of Diabetes Mellitus and Obesity and the Overlap of Comorbidities in HIV+ Hispanics Initiating Antiretroviral Therapy
Trauma, Discrimination, and Links to Diabetes
- Adverse Childhood Experiences and the Risk of Diabetes: Examining the Roles of Depressive Symptoms and Cardiometabolic Dysregulations in the Whitehall II Cohort Study
- Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis
- Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women: A 22-Year Longitudinal Study
- The Link Between Mental Trauma and Diabetes
- How and Why Weight Stigma Drives The Obesity ‘Epidemic’ and Harms Health
- Obesity Stigma: Important Considerations for Public Health
- Perceived Weight Discrimination and Chronic Medical Conditions in Adults with Overweight and Obesity
- The Stigma of Obesity: A Review and Update
- Why Weight? Improving the health of LGBTQIA+ patients by reducing 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.