Prediabetes: Resources for Providers

Patients can have prediabetes for years without showing any symptoms. That’s why it’s important to encourage patients who show one or more risk factors to take the 60-Second Type 2 Diabetes Risk Test by American Diabetes Association (ADA). One risk is having a family history of diabetes. Other risk factors include having had gestational diabetes, being overweight, or being physically inactive.

Having these conversations with patients aren’t always easy, especially if a patient has been dealing with trauma, shame, and stigma from being overweight. Fat shaming is a real byproduct of societal stigma, one that we often don’t take under consideration in public health work (Puhl & Heuer, 2012). Negative attitudes invade medical facilities. This leads to patients being turned away for care or needing treatment for medical conditions that are instead blamed on their weight (Udo, Purcell, & Grillo, 2016).

Unfortunately, that stigma likely increases the harm done when we approach discussions of weight and obesity from a clinical, one-size-fits-all standpoint. This approach could lead to increased weight (Tomiyama, et al., 2018). We must find ways to discuss weight that are culturally competent, kind, and compassionate.

Many tools used to measure, monitor, and curb obesity may not be effective for evaluating weight for some people. For example, body mass index (BMI) was developed and tested on white cisgender men. The index hasn’t been updated in most cases to fit the needs of communities of other races, ethnicities, genders, sexes, and more (Dougherty, et al., 2020; Mittal, et al., 2004; Harvard T.H. Chan School of Public Health, 2021). It’s important to acknowledge this history to:

1. Properly measure and interview patients, versus relying simply on the patient’s BMI.
2. Further recognize the ways inequity operates within public health and medicine.
3. Build trust within communities harmed by exclusion and oppression.

This doesn’t mean we can’t use BMI or similar methods. In fact, many spaces across health care, public health, and the National Diabetes Prevention Program continue to use BMI. The key is to realize that BMI is just one tool to fight obesity. There are other tools in your toolbox. Remember that not every tool will fit every need. When assessing a patient’s risk, take time to discuss the patient’s whole health.

• Assess all the patient’s risk factors.
• Calculate if BMI is 25 or higher.
• Determine whether a diagnostic test has been run within the past year.

If you’re treating a patient who is at risk for prediabetes, consider screening them for higher than normal blood sugar. Look for test results in any one of the following prediabetes ranges:

• Hemoglobin A1C of 5.7-6.4%
• Fasting plasma glucose of 100-125mg/dL
• Two-hour plasma glucose (after a 75-gram glucose load) of 140-199 mg/dL

Start by talking with your patients about their environment, experiences, and other daily factors that impact their chances for good health. Help patients learn about and avoid harmful methods to lose weight. For example, many forms of dieting have been shown to lead to higher incidences of cardiovascular events and even death (Bangalore, et al., 2017).

Televised shows and online videos that glorify dieting often don’t show the long-term struggles faced by those who undergo massive weight loss. Challenges include keeping off the weight, as well as sustaining their extreme diets and/or exercise routines.

Based on each patient’s situation, help them connect with tools and resources that could work for them, including a CDC-recognized lifestyle change program. Patients are more likely to join with your encouragement. They’re more likely to succeed when their provider listens and recommends a program that considers all of their Social Determinants of Health.

Acceptance in most lifestyle change programs include all the following criteria:

• 18 years old or older
• Most recent BMI of 25 or higher
• A positive diagnostic test result with the previous 12 months, history of gestational diabetes mellitus, or high-risk result on the 60-Second Type 2 Diabetes Risk Test
• Not pregnant
• No previous diagnosis of type 1 or type 2 diabetes

Discuss the patient’s diagnosis, blood sugar health, and lifestyle choices at every visit. Their long-term relationship with you will help them sustain success long after they reverse prediabetes or complete the program.

• Use a motivational interview approach, including being nonjudgmental about weight and BMI.
• Encourage them to start small and set realistic goals for better nutrition, increased physical activity, and reduced stress.
• Provide patient-focused toolkits like the CDC’s On Your Way to Preventing Type 2 Diabetes (PDF) for guidance between appointments.
• Help patients find a lifestyle change program that fits their specific needs.