The push to diagnosis pre-diabetes

We anticipated this. The data show that we can decrease the onset of diabetes mellitus. Concerns over ‘pre-diabetes’ on the rise.

Identifying people at risk for diabetes “is a big task,” said Frank Vinicor, diabetes program director for the U.S. Centers for Disease Control and Prevention. “If we don’t identify pre-diabetes and stop the development of Type 2 diabetes, the health-care system is going to be completely overwhelmed.”

Public health officials have only recently gotten enough ammunition to address pre-diabetes. Experts estimate the number of Americans with the condition to be 16 million. A major study last year showed that many could delay and even prevent diabetes by eating a healthy diet, exercising 30 minutes a day, and losing a little weight.

Just using the word prevention in the same sentence with diabetes is a sea change in thinking. Until a decade ago, health-care providers largely concerned themselves with treating complications of the disease, which can be fatal. A few years later, it became clear that some of the complications could be staved off if patients kept their blood-sugar levels under control.

…

Physicians already have to squeeze quite a bit into a 15- or 20-minute checkup, from breast exams to colon-cancer screenings. To ensure that diabetes screenings are done, he said, he will push for reimbursement from private and government insurers.

I do believe that we can decrease the onset of diabetes. Someone needs to show this skeptic that the pre-diabetes label will make the patient more likely to change their diet and exercise. We will probably resort to drug therapies to decrease the onset. Few patients modify their lifestyle. Before spending dollars on a campaign, why do we not find out that “labelling” patients actually helps them.

I appreciate them noting the 15-20 minute visit. We need to hammer this point over and again. Generalists can address many issues – and would like to address them. It takes time. Recalling off the top of my head, we are now asked to (1) screen for alcohol disorders, (2) ask about tobacco and counsel smokers how to stop, (3) screen for depression, (4) keep up to date on recommended prevention, (5) counsel on diet and exercise – and I probably have left out a few. These considerations are in addition to the increasingly complexity of care. Each year we have more that we can do to help patients – but good care requires time – time for communication, time to ask the patient important questions, time for the patient to present their agenda. Why won’t anyone pay for that time? They (the insurers) are telling us that what we do is not that important. While the message is implicit, it is still powerful.