Why some patients don't take prediabetes seriously

Tanya Albert Henry , Contributing News Writer

When you tell some patients they have prediabetes, they may not feel that it rises to the top of their priority list. But by reframing the discussion around your patient’s goals, you can help them learn how to stop prediabetes from developing into type 2 diabetes.

Some patients may tell themselves—even if presented with a type 2 diabetes diagnosis will mean—that it’s nothing to worry about because they don’t actually have diabetes yet. And, they reason, at some point in the future they will do something to stop their condition from becoming more serious.

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So how do you get these patients to take the prediabetes diagnosis seriously sooner and take meaningful action to change their health trajectory? Experts say the key to breaking through is taking the abstract concept of preventing something that may be 10 years down the road and turning it into something that is more concrete.

One way to help patients make changes before it is too late is to put it into terms they can relate to now.

For example, tackle the topic as weight loss. Talk to the patient about attending a lifestyle change program that can help them lose weight, something that most patients want to do anyway.

Another approach: Talk to the patient about what they want in the future. Do they want to be more active with their children or grandchildren? Do they want to be around longer to have more time to spend with loved ones? Is there a once-in-a-lifetime vacation they want to be healthy enough to take?

Once you understand a patient’s values and goals, you can frame the conversation in a way that contextualizes what is important to the patient and lay out ways that you can help them achieve those goals.

Now that you have reframed the discussion in a way that enables patients to understand why change is important to achieving their own goals, they need to hear something from the physician beyond the traditional advice of a healthier diet and more exercise.

The “doing something about it” piece is even tricky for patients who recognize the meaning of their diagnosis and are immediately compelled to make changes—a category that most patients fall into.

Fortunately, there are an increasing number of lifestyle change programs to which physicians can refer patients for help, guidance and support from a coach and group.

With 84 million U.S. adults having prediabetes, the Centers for Disease Control and Prevention (CDC) created the National Diabetes Prevention Program which includes website that allows physicians to type in a location and find CDC-recognized lifestyle change programs nearby.

Physicians who want to help their patients with prediabetes may need to change their own mindset on the topic and begin thinking of prediabetes as something for which they need to write a referral.

“Many doctors are not aware of lifestyle change programs,” said Kate Kirley, MD, director of chronic disease prevention at the AMA. “And the key message to patients is that there is a program that will help you.”

What about patients who say the program too far away, or too inconvenient to attend? Telehealth can allow a patient to participate in a program remotely. Online programs are popping up as well, including Omada and Noom.

Cost concerns? Out-of-pocket costs will vary for patients, but there are many ways to offset what patients pay. Commercial insurers often cover costs, Medicare started covering the program for eligible Part B beneficiaries earlier this year, and a number of programs have grants that can reduce costs.

How do I know if a patient is following through with the recommended program? A physician can ask the lifestyle change program to let the office know whether a patient has enrolled and ask for feedback on the patient’s participation and weight loss.

With that information, doctors can decide if the patient needs to come back for an office visit. Physicians also can set up their electronic health systems to help track and generate reminders for patients with prediabetes to come in for blood tests and other monitoring.

The AMA is improving the health of the nation by confronting the increasing chronic disease burden. The AMA’s work to prevent type 2 diabetes is centered on building clinical-community linkages that will enhance the delivery of care and enable physicians and health teams to partner with patients to achieve better health for all.