Johns Hopkins researchers who distributed a survey at a retreat and medical update for primary care physicians (PCPs) report that the vast majority of the 140 doctors who responded could not identify all 11 risk factors that experts say qualify patients for prediabetes screening. The survey, they say, is believed to be one of the first to formally test PCPs’ knowledge of current professional guidelines for such screening.

Of the providers who completed the survey, 6 percent correctly identified all of the risk factors that should – under guidelines issued by the American Diabetes Association – prompt prediabetes screening and 17 percent correctly identified the fasting glucose and HbA1c (a measure of glucose that attaches to the protein in red blood cells which carry oxygen), laboratory values for diagnosing prediabetes. On average, the respondents selected eight out of the 11 correct risk factors for prediabetes screening.

A report of the survey’s findings, published July 20 in the Journal of General Internal Medicine, also found that nearly one–third of the PCPs were unfamiliar with the American Diabetes Association’s (ADA) guidelines for prediabetes.

“We think the findings are a wake–up call for all primary care providers to better recognize the risk factors for prediabetes, which is a major public health issue,” says Eva Tseng, MD, MPH, an assistant professor at the Johns Hopkins University School of Medicine and the paper’s first author.

An estimated 90 percent of individuals with prediabetes, however, are unaware of their condition, according to the CDC.

To better understand why so many with prediabetes go undiagnosed, Tseng and the research team created a survey to test awareness of expert prediabetes guidelines and beliefs regarding prediabetes management.

At an annual retreat and medical update held for Mid–Atlantic region primary care physicians in 2015, the researchers invited all 156 PCPs who attended the meeting to participate in the on–site survey. The survey asked PCPs to select prediabetes risk factors from a list of factors recommended by the ADA guidelines for the screening of prediabetes. The survey also asked the PCPs to identify guidelines issued by the ADA about prediabetes screening; numerical values corresponding to the upper and lower limits of the fasting glucose and HbA1c laboratory criteria for diagnosing prediabetes; values corresponding to the ADA’s recommendations for minimum weight loss and minimum physical activity for patients with prediabetes; best initial management approach to a patient with prediabetes; prediabetes screening tests used; initial patient management approaches; and intervals used for repeat lab work and follow–up visits.

To evaluate attitudes and beliefs regarding prediabetes, the survey asked providers to rate, on a five–point scale (strongly agree to strongly disagree), whether they believe it is important to identify prediabetes and whether they believe that lifestyle modification and metformin can reduce the risk of progression to diabetes. A similar scale was used to evaluate what providers perceive as patient barriers to lifestyle modification and the use of metformin.

While only 11 percent of physicians selected referral to a behavioral weight loss program as the recommended initial management approach to prediabetes, 96 percent selected counseling on diet and physical activity. The survey also revealed that metformin use for prediabetes was uncommon: 25 percent of providers never prescribed metformin and 16 percent of providers did not believe in prescribing metformin for patients with prediabetes.

Prediabetes is diagnosed by labs, specifically an elevated fasting glucose of 100–125 mg/dL or hemoglobin A1c of 5.7–6.4 percent.