This is going to be a short video talking about the state of the art in
terms of primary care physician awareness of prediabetes,
their knowledge, practices, and perceptions. We get this kind of
complaints a lot in terms of when we keep discovering. And I discovered two or
three a month patients that have full-blown diabetes, not just
prediabetes. And their doc didn't know it. They didn't know it, and you get a lot
of hate or comments about that. But I would say, look before you criticize
primary care docs walking a mile in their moccasins. Life is not so easy for
primary care docs. You got patients that don't want to lose weight that need to.
You've got patients that want to take a drug or a supplement to overcome a
lifestyle issue. Meanwhile, you've got insurance companies bearing down on them
to see more and more patients and deliver more and more "care," which
they define as writing scripts. So there's a lot of challenges in that
space. This is a video... this video just briefly describes the state of the art
in terms of knowledge, attitude, practices, and perceptions for primary
care docs around prediabetes.
This was done... it was published in the Journal of General Internal Medicine
September 9th, 2019. And as you can tell, this mostly came out of my old alma
mater at Hopkins... bunch of folks from Hopkins involved in developing this. Now
again, we get a lot of comments because people get frustrated that their docs
don't know about the five stages of diabetes, the different types of
prediabetes profiles you get on on a Kraft insulin survey. Or they don't even
know about oral glucose tolerance test, except for pregnant women and even that
they don't know about. So let's just talk very briefly about the national survey.
So basically, the background is, despite strong evidence of national
policy supporting type 2 diabetes prevention, very little is known about
type 2 diabetes prevention in the primary care setting. They did a
cross-sectional mailed survey to assess primary care physicians' knowledge,
practice, and perceptions. So here are the results. This was going out to about a
thousand people. 33 percent or to 298 responded they had limited knowledge of
risk factors for prediabetes screening, laboratory, diagnostic criteria
for prediabetes and management recommendations for prediabetes. Only 36
percent of the primary care patients were actually referred first to
lifestyle management. The initial approach for 43 percent of these folks
was to go with a medication. Just give them metformin. The PCPs believed...
primary care physicians believed that there are two types of barriers to
diabetes prevention at the individual level. One was the patient's own lack of
motivation and the other was lack of system level resources (for example, not
having weight loss clinics that they could refer patients to). So as you see,
we've got a major problem here. Patients are blaming docs, and insurance companies
insurance companies are blaming docs, and patients and docs are both blaming
insurance companies and patients. Everybody's doing this. We need to get
together, start thinking a little bit, more teamwork associated. The conclusions
that they came up with was that addressing gaps in the PCP knowledge may
improve the identification and management of people with prediabetes
but there are also systems issues that we need to work on. Thank you for your
interest. Very frustrating. This is Ford Brewer. I started off my career as an ER doc. And
that can be frustrating because most of the things bringing patients into the ER
can and should be prevented, like heart attack and stroke. So I went to Johns
Hopkins for training in prevention, did well, ended up running the program,
trained dozens of docs there, and have trained hundreds and even over a
thousand doctors since then in preventing disease. What's even more
important is I've helped thousands of patients prevent heart attack and stroke
rather than waiting for the devastation and hoping for a cure.