Table 2.
Reported Knowledge, Practices, and Perceptions of Barriers/Interventions for Prediabetes
| N (%) | |
|---|---|
| Knowledge of recommendations for management of prediabetes | |
| Initial management approach* | |
| Refer to diabetes prevention lifestyle change program | 88 (29.7) |
| Counseling on diet changes and physical activity | 209 (70.1) |
| Refer to nutritionist | 50 (16.8) |
| Discuss starting metformin | 53 (17.8) |
| Refer to bariatric surgery | 9 (3.0) |
| 150 min/week of physical activity | 120 (41.0) |
| 7% body weight loss | 22 (7.6) |
| Practice behaviors | |
| Initial management approach* | |
| Refer to diabetes prevention lifestyle change program | 107 (35.9) |
| Counseling on diet changes and physical activity | 276 (92.6) |
| Refer to nutritionist | 123 (41.3) |
| Discuss starting metformin | 128 (43.0) |
| Refer to bariatric surgery | 30 (10.1) |
| Repeat lab work | |
| 3 months | 126 (42.9) |
| 6 months | 133 (45.2) |
| 1 year | 24 (8.2) |
| Return for follow-up clinic visit | |
| 3 months | 128 (43.5) |
| 6 months | 124 (42.2) |
| 1 year | 16 (5.4) |
| Patients with prediabetes you have prescribed metformin | |
| 0% | 44 (15.2) |
| 1–5% | 78 (27.0) |
| > 5–25% | 88 (30.5) |
| > 25–50% | 45 (15.6) |
| > 50–75% | 24 (8.3) |
| > 75% | 10 (3.5) |
| Patient and system barriers to lifestyle modification (strongly agree or agree) | |
| Patient’s lack of motivation | 275 (93.9) |
| Patient’s lack of time | 201 (69.1) |
| Patient’s lack of knowledge of what to do for lifestyle change | 199 (69.1) |
| Patient’s physical limitation in doing activity | 158 (54.1) |
| Stress in patient’s life | 204 (69.9) |
| Limited or lack of success with prior lifestyle modification | 230 (79.3) |
| Lack of weight loss and/or nutrition resources for patient | 176 (60.7) |
| Patients do not think it is important to make these changes | 168 (57.7) |
| Financial limitations | 130 (44.7) |
| Lack of safe community spaces for engaging in physical activity | 67 (22.9) |
| Limited access to grocery stores and healthy food options | 77 (26.5) |
| Patient and system barriers to metformin use (strongly agree or agree) | |
| Patients dislike taking medications | 254 (87.0) |
| Medication cost to patient | 92 (31.6) |
| Poor patient adherence | 227 (77.5) |
| Potential side effects | 216 (74.0) |
| Contraindication such as chronic kidney disease | 159 (54.4) |
| Physicians’ lack of awareness of clinical guidelines for metformin use | 162 (55.3) |
| Physician’s belief that patients can improve with lifestyle change | 203 (68.8) |
| Lack of FDA approval for metformin use in prediabetes | 109 (37.2) |
| Interventions to improving management of prediabetes (strongly agree or agree) | |
| More time for doctors to counsel patients | 226 (76.9) |
| Patient counseling by nurse | 218 (74.7) |
| Increased physician education about prediabetes | 220 (75.3) |
| Educational materials for patients | 221 (77.0) |
| Increased availability of Diabetes Prevention Programs | 265 (90.1) |
| Increased insurance coverage of Diabetes Prevention Programs | 263 (89.5) |
| Improved nutrition resources for patients | 258 (87.8) |
| Improved access to weight loss programs | 250 (85.9) |
| Coordinating patient’s referral to lifestyle change program | 244 (83.6) |
| Clinical decision support tools | 190 (64.6) |
| Physician incentives | 129 (43.7) |
*Adds up to > 100% because more than one answer could be selected