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UF Study: Most Cases of Prediabetes Are Going Untreated

Jon Hemstreet, M.D., a family medicine physician at Gainesville Family Physicians, reviews each patient’s health information before meeting with them. Hemstreet advises patients to be an advocate for their own healthcare and encourages them to ask their doctor if they are at risk for diabetes. (Dakota Sproule/WUFT News)
Jon Hemstreet, M.D., a family medicine physician at Gainesville Family Physicians, reviews each patient’s health information before meeting with them. Hemstreet advises patients to be an advocate for their own healthcare and encourages them to ask their doctor if they are at risk for diabetes. (Dakota Sproule/WUFT News)

More than a third of U.S. adults are prediabetic. Without preventative lifestyle changes, such as diet and exercise, they're at risk of developing diabetes.

But less than one-fourth of patients with prediabetes receive treatment from primary care physicians, according to a University of Florida study.

The findings indicate doctors are missing opportunities to treat people with prediabetes, leaving many cases undiagnosed and untreated, said Arch G. Mainous III, Ph.D., chair of the department of health services research, management and policy in the UF College of Public Health and Health Professions.

Most people have prediabetes, a state in which the body has higher levels of glucose than normal but not levels high enough to be considered diabetes, before developing Type 2 diabetes, according to the American Diabetes Association. Type 2 diabetes, the most common form of diabetes, occurs when the body can't produce enough insulin to maintain normal levels of blood glucose.

About 90 percent of people with prediabetes don’t realize they have it, and about 15 to 30 percent of people with prediabetes will develop diabetes within 5 years, Mainous said.

The goal is for physicians to detect prediabetes so doctors and patients can create a treatment plan, Mainous said.

From 2012 to 2014, 15,597 Floridians died from diabetes, according to the Florida Department of Health, Bureau of Vital Statistics. During that time span, the most diabetes-related deaths in Florida occurred in Miami-Dade County where 1,929 people died from this disease. Many other Florida counties were affected, including Alachua County where 209 people died from diabetes.

"Even with blood test results in front of them, physicians weren’t detecting prediabetes in their patients in terms of making a diagnosis or providing some sort of management or treatment," Mainous said in a UF news release.

The study used data from the 2012 National Ambulatory Medical Care Survey, a national sample survey of office-based physician visits, to estimate how many people with prediabetes are being diagnosed or treated. The patients in the survey were 45 or older and had received blood tests within 90 days of their visit. About 34 percent of patients had a blood-glucose level in the prediabetic range.

Prediabetes can be prevented or slowed with lifestyle changes including diet and exercise, Mainous said. However, in some cases, a drug called metformin can be used to help prevent the transition to diabetes.

More than 60 percent of adults in Florida are overweight or obese, according to the Florida Department of Health.

Lifestyle changes may be difficult, but they're effective, Mainous said.

Mainous is currently conducting a survey to determine why prediabetic patients aren’t being treated.

Dr. Michael Haller, a pediatric endocrinologist at UF, agrees diabetes is a huge problem.

“It’s a silent disease,” Haller said. “Unless you’re looking for it you don’t know that you have it.”

The current health care system doesn’t provide health care workers with the time and money needed to provide patients with the proper guidance, Haller said.

“The reason we care about diabetes is because of all the complications associated with it,” Haller said. “That’s what shortens lives.”

Diabetes can cause other health complications such as kidney disease, vision problems and heart disease, Haller said. However, patients with prediabetes can often avoid developing Type 2 diabetes by eating healthy and exercising.

“Prediabetes gives you the opportunity to change your diagnosis,” Haller said. “There’s not many things in medicine where you can do that.”

Type 2 diabetes is often a weight-related issue, said Dr. Jon Hemstreet, a family medicine physician at Gainesville Family Physicians.

“Weight loss is a challenge in society because of our access to junk food,” Hemstreet said. “It’s a perfect storm for people to be overweight.”

Individuals with a body mass index above 25 that also have a family history of diabetes or gestational diabetes or are inactive, have hypertension or have abnormal cholesterol are at high risk and should be aggressively screened for diabetes, he said.

Physicians often don’t have the time necessary to elaborate on the lifestyle changes that need to be made, Hemstreet said. Patients with prediabetes should seek dietary or nutritional counseling for further guidance on how to prevent diabetes and maintain a healthy lifestyle.

“Doctors don’t have as much time with their patients as they’d like,” Hemstreet said. “We don’t want things swept under the rug, but the patient has to be active in the process.”

Part of a physician’s job is to motivate patients, but the patient has to choose to change their life, he said.

Hemstreet advises patients to hold their doctors accountable. Patients should ask if they are at risk for diabetes and if so what they should do about it.

“Be an advocate for yourself and your loved ones,” he said.

Dakota is a reporter for WUFT News and can be contacted by calling 352-392-6397 or emailing news@wuft.org.