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Prevention of Diabetes Mellitus in Patients With Prediabetes.

ABSTRACT: Cardiovascular disease is a leading cause of death in patients with diabetes. Consequently, as antidiabetic medications have demonstrated cardiovascular benefit, cardiologists have been asked to weigh in regarding antidiabetic therapy. The cardiologist's role will continue to grow as antidiabetic agents with cardiovascular benefit are being studied in prediabetes as part of an evolving clinical environment. Still, current guidelines primarily recommend high-intensity lifestyle intervention or metformin for diabetes prevention. Considering that many patients cared for by a cardiologist will have prediabetes, we propose herein that cardiologists can also facilitate diabetes prevention through direct intervention, referring patients to community-based high-intensity lifestyle interventions, and through advocacy, policy, and additional guideline development. The most important messaging for a patient is that avoiding new-onset diabetes can reduce microvascular disease, reduce healthcare cost, and improve health-related quality of life. Moreover, as the mortality risk of patients with a history of myocardial infarction and diabetes is almost double that of patients with a history of myocardial infarction who are free of diabetes, there is even more potential benefit in delaying and/or avoiding diabetes in patients with cardiovascular disease. Despite these important health advantages, the implementation of diabetes prevention strategies is lagging. The under implementation may be exaggerated by published opinions conflicting major guidelines in addition to conflicting guideline recommendations. In conclusion, we propose cardiologists can play a key role in preventing diabetes and aligning practice patterns with guideline recommendations among endocrinology, cardiology, and primary care stake holders.

SUBMITTER: Carris NW

PROVIDER: S-EPMC6350898 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Prevention of Diabetes Mellitus in Patients With Prediabetes.

Carris Nicholas W NW Magness Ronald R RR Labovitz Arthur J AJ

The American journal of cardiology 20181106 3

Cardiovascular disease is a leading cause of death in patients with diabetes. Consequently, as antidiabetic medications have demonstrated cardiovascular benefit, cardiologists have been asked to weigh in regarding antidiabetic therapy. The cardiologist's role will continue to grow as antidiabetic agents with cardiovascular benefit are being studied in prediabetes as part of an evolving clinical environment. Still, current guidelines primarily recommend high-intensity lifestyle intervention or me ...[more]

PMID: 30528418

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Project description:BackgroundThe United States has 84 million adults with prediabetes, putting them at a higher risk than the general population for developing type 2 diabetes. Missed opportunities among primary care providers in diagnosing and managing patients with prediabetes represent a gap in care, suggesting there is a need to educate practicing physicians and medical students about diabetes prevention. The purpose of this study is to assess medical students' basic knowledge of prediabetes and diabetes prevention, identify potential educational needs, and target areas for improvement in undergraduate medical education curricula.MethodsA cross-sectional study to assess medical students' preclinical and clinical management knowledge of prediabetes and diabetes prevention. Medical students attending the 2016 American Medical Association's annual meeting took a 6-item knowledge questionnaire using a mobile application or a paper version. Scores were reported for the full sample of respondents, by year in medical school, by topic area, and by mode of survey response.ResultsThe average student answered fewer than half of the questionnaire questions correctly. Scores on some items addressing preclinical content were higher among third- and fourth-year students compared to first- and second-year students (p?=?0.039 and effect size?=?0.363). Average scores on the items addressing clinical management were not significantly different by year in medical school, but the item measuring effectiveness of metformin to a lifestyle change program had 41.9% correct answers among the mobile application respondents compared to 21.5% among paper test respondents (p?=?0.003 and effect size?=?0.463).ConclusionsMedical student performance on the prediabetes knowledge questionnaire was low. Students' year in medical school had a slight impact on overall performance, but only for certain questions. The results suggest the need for improvements in current medical school curricula for increasing the awareness of screening for prediabetes as well as the benefits of the lifestyle change programs in the National Diabetes Prevention Program.

Project description:BACKGROUND:The Centers for Disease Control and Prevention (CDC) diabetes prevention program (DPP) has formed the foundation for Type 2 Diabetes Mellitus (T2DM) prevention efforts and lifestyle change modifications in multiple care settings. To our knowledge, no randomized controlled trial has verified the efficacy of a fully mobile version of CDC's diabetes prevention program (DPP). OBJECTIVE:This study aimed to investigate the long-term weight loss and glycemic efficacy of a mobile-delivered DPP compared with a control group receiving usual medical care. METHODS:Adults with prediabetes (N=202) were recruited from a clinic and randomized to either a mobile-delivered, coach-guided DPP (Noom) or a control group that received regular medical care including a paper-based DPP curriculum and no formal intervention. The intervention group learned how to use the Noom program, how to interact with their coach, and the importance of maintaining motivation. They had access to an interactive coach-to-participant interface and group messaging, daily challenges for behavior change, DPP-based education articles, food logging, and automated feedback. Primary outcomes included changes in weight and hemoglobin A1c (HbA1c) levels at 6 and 12 months, respectively. Exploratory secondary outcomes included program engagement as a predictor of changes in weight and HbA1c levels. RESULTS:A total of 202 participants were recruited and randomized into the intervention (n=101) or control group (n=99). In the intention-to-treat (ITT) analyses, changes in the participants' weight and BMI were significantly different at 6 months between the intervention and control groups, but there was no difference in HbA1c levels (mean difference 0.004%, SE 0.05; P=.94). Weight and BMI were lower in the intervention group by -2.64 kg (SE 0.71; P<.001) and -0.99 kg/m2 (SE 0.29; P=.001), respectively. These differences persisted at 12 months. However, in the analyses that did not involve ITT, program completers achieved a significant weight loss of 5.6% (SE 0.81; P<.001) at 6 months, maintaining 4.7% (SE 0.88; P<.001) of their weight loss at 12 months. The control group lost -0.15% at 6 months (SE 0.64; P=.85) and gained 0.33% (SE 0.70; P=.63) at 12 months. Those randomized to the intervention group who did not start the program had no meaningful weight or HbA1c level change, similar to the control group. At 1 year, the intervention group showed a 0.23% reduction in HbA1c levels; those who completed the intervention showed a 0.28% reduction. Those assigned to the control group had a 0.16% reduction in HbA1c levels. CONCLUSIONS:This novel mobile-delivered DPP achieved significant weight loss reductions for up to 1 year compared with usual care. This type of intervention reduces the risk of overt diabetes without the added barriers of in-person interventions. TRIAL REGISTRATION:ClinicalTrials.gov NCT03865342; https://clinicaltrials.gov/ct2/show/NCT03865342.

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Prevention of Diabetes Mellitus in Patients With Prediabetes.

Publications

Prevention of Diabetes Mellitus in Patients With Prediabetes.

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