Why Aren’t More People Treated for Prediabetes?

It's important to know the facts so you can begin reversing diabetes—or lower your risk of getting it to begin with.

Healthcare provider lances a person's finger to check their blood sugar

Medically reviewed in May 2021

Updated on March 10, 2022

Roughly one in three adults in the United States—or 88 million people—have prediabetes, a condition in which blood sugar is abnormally high, but not high enough to be considered diabetes. Prediabetes is a warning sign that diabetes may be in your future, and it’s also a risk factor for heart disease and stroke.

But shockingly, of those Americans who have prediabetes, a whopping 84 percent don’t even know it. Why is that, and what role do healthcare providers (HCP) play in this apparent disconnect? 

In search of answers, a group of researchers at the University of Florida analyzed data from a 2012 government survey of HCPs. They looked at patients aged 45 and up who'd had an A1C blood test, used to measure average blood sugar, within 90 days of their healthcare visit. The scientists found that 34 percent of the patients had blood sugar levels in the prediabetes range. Of these, only 23 percent were in treatment, either by way of being prescribed medication or lifestyle changes. The findings were published in Journal of the American Board of Family Medicine in 2016.

Why did more than three out of four people not receive prediabetes treatment?

Breaking bad habits 
One issue may be that many HCPs don’t see prediabetes as an immediate cause for concern and don’t provide recommendations that can begin helping right away, says Jack Merendino, MD, an endocrinologist at George Washington University School of Medicine in Washington, DC and Johns Hopkins Medicine in Baltimore.

The go-to treatments for prediabetes are lifestyle modifications, which often require a detailed conversation with one’s HCP. That can present a snag, according to Dr. Merendino.

“There’s a lot of evidence that doctors are not good at recommending lifestyle changes,” Merendino says. “In the physician’s mind, what’s going on is that there’s an impending problem, but it’s not yet bad enough to need medication. Doctors tend to look at treatment as medication.” 

One reason HCPs don’t often recommend lifestyle modification—such as eating a healthy diet and exercising regularly—is the perception that patients don’t follow their orders. Even so, Merendino thinks HCPs often underestimate the influence they have with their patients.

“A fair number of patients do make changes when recommended by doctors,” he says.

Perceived lack of urgency 
Another reason for the low numbers of diagnoses, Merendino says, is that some doctors don’t see prediabetes as urgent. Controlling diabetes often means getting A1C levels down to under 7 percent, which is still above the level considered to be prediabetes.

“Physicians are saying it’s not as much of a big deal, rather than thinking that if the patient is prediabetic then they might develop diabetes,” Merendino says.

Meanwhile, progressing from prediabetes to diabetes usually takes years. “It’s seen as an issue, but an issue for the future,” Merendino explains. 

Still, a diagnosis of prediabetes should be taken seriously. It is not a benign condition. For example, by the time many people are diagnosed with diabetes, they already have neuropathy, or nerve damage. That means at least some patients developed neuropathy while they were in the prediabetes stage, Merendino explains.

“It’s not like you’re fine with prediabetes and then you get complications when you reach diabetes levels,” he notes. 

The truth is that a diagnosis of prediabetes is an excellent opportunity to try to fend off diabetes. If patients know they have it, they can take action.

Should you be tested? 
Prediabetes usually has no obvious symptoms, so it’s important to look for it. If you’re 45 or older (the age when risk increases), consider being tested, especially if you’re overweight or obese. You should also consider being tested if you’re under 45, overweight or obese, and have additional risk factors such as family history of diabetes, physical inactivity, high blood pressure, low HDL (aka “good” cholesterol), orpolycystic ovary syndrome. 

Reversing prediabetes 
If you are diagnosed with prediabetes, there’s no need to panic. Having prediabetes doesn’t mean diabetes is your destiny. Still, between 15 and 30 percent of people do develop diabetes within five years of a prediabetes diagnosis. And the longer you have elevated blood sugar, the more likely diabetes becomes, Merendino says. So think of a prediabetes diagnosis as a signpost directing you to change your path.

“Patients should be asking, ‘How do I prevent myself from progressing to diabetes?’” Merendino says. “Doctors’ recommendations should be lifestyle modifications: weight loss and physical activity.” According to the Centers for Disease Control and Prevention, eating healthy and being active can cut the risk of type 2 diabetes in half. 

The Diabetes Prevention Program, a major study that followed more than 3,200 people in 27 clinical centers for about three years, showed that lifestyle changes were about twice as effective as medication at preventing the development of diabetes. People in the landmark study, which was published in the New England Journal of Medicine in 2002, saw success even at modest levels of weight loss.

Exercise does double duty: Not only does it help to keep the weight off, but it also helps the body use insulin more efficiently. Today, following a lifestyle change program recognized by the CDC can cut your risk for diabetes by more than half. (Find a program in your area.)

“For exercise to do twice as good as drugs—that was really major,” says Merendino. “If there’s a failure here, it’s a failure on the part of physicians to internalize the powerful effect that lifestyle intervention can have.” 

Article sources open article sources

Mayo Clinic. Prediabetes. September 22, 2020.
Centers for Disease Control and Prevention. Prediabetes. Page last reviewed February 11, 2021.
Mainous AG 3rd, Tanner RJ, Baker R. Prediabetes Diagnosis and Treatment in Primary Care. J Am Board Fam Med. 2016;29(2):283-285.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
American Diabetes Association. Join a CDC-recognized lifestyle change program. Accessed March 10, 2022.

 

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