Management of Prediabetes: A Comparison of the Treatment Approaches Utilized by a Family Practice Clinic and an Internal Medicine/Endocrinology Practice

• Published in: Journal of pharmacy practice 2015-02, Vol.28 (1), p.86-92
• Main Authors: Anderson, Zachary L., Scopelliti, Emily M., Trompeter, Jessica M., Havrda, Dawn E.
• Format: Article
• Language: English
• Subjects: Adult; Blood Glucose; Counseling; Diet; Disease Management; Endocrinology - methods; Exercise; Family Practice - methods; Female; Glycated Hemoglobin A; Guideline Adherence - statistics & numerical data; Health Behavior; Humans; Hypoglycemic Agents - therapeutic use; Internal Medicine - methods; Life Style; Male; Middle Aged; Patient Education as Topic; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Prediabetic State - drug therapy; Prediabetic State - therapy; Random Allocation; Retrospective Studies
• ISSN: 0897-1900; 1531-1937
• DOI: 10.1177/0897190013514089

Purpose: To compare the management of prediabetes between a family practice clinic and internal medicine/endocrinology practice. Methods: A randomized, retrospective evaluation of the medical history in 168 eligible patients with a diagnosis of prediabetes or abnormal blood glucose (BG) at a family practice clinic (n = 78) and an internal medicine/endocrinology practice (n = 90). Results: The internal medicine/endocrinology practice provided more counseling regarding lifestyle modifications (91.1% vs 76.9%, P = .039), specific physical activity recommendations (26.7% vs 7.7%, P = .003), and recommended more patients receive 150 minutes/week of moderate exercise (8.9% vs 1.3%, P = .038). The family practice clinic provided more written dietary information (16.9% vs 13.3%, P = .044) and specific weight loss goals (20.5% vs 6.7%, P = .015). The internal medicine/endocrinology practice initiated pharmacological therapy in more patients (51.1% vs 3.8%, P< .001) and had a significant decrease in fasting BG from baseline compared to the family practice clinic (−9.0 vs −5.6 mg/dL, P< .001). Conclusion: Providers are likely to initiate nonpharmacological therapy but may not provide specific education recommended by the American Diabetes Association. The integration of a multidisciplinary team to provide guideline-based nonpharmacologic counseling may be beneficial in improving outcomes in the management of prediabetes.