Using a simple blood test to screen at-risk populations for diabetes can be an effective tool in improving patient health. Eugenie M. Komives, MD, a Duke primary care physician, says even positive results motivate patients to change behaviors.
The US Preventive Services Task Force (USPSTF) recommends that adults aged 40 to 70 years who are overweight or obese be screened for abnormal blood glucose levels.
USPSTF notes that this is an evidence-based recommendation, with clinical trials showing that people who are screened and follow an intervention can reduce their risk of progression to diabetes. USPSTF also says that lifestyle interventions have a greater benefit than drugs, such as metformin, which are the next step in treatment.
Komives says that this recommendation is important because approximately 65% of North Carolinians are overweight or obese. That statistic is a factor that puts the state in the “diabetes belt,” and most patients have an affected family member. So, Komives says, “most everybody is aware of diabetes as a disease and the unfortunate consequences of long-term, poorly managed diabetes.”
Duke endocrinologists encourage primary care physicians in their network to conduct diabetes screening when possible. “It’s a relatively simple, proactive step that can pay a lifetime of dividends,” says Susan E. Spratt, MD, a Duke endocrinologist who works with Komives.
Komives agrees: “If I find prediabetes, in general, patients are anxious about it. I have found that it is a wonderful motivator for improvement in lifestyle. I spend a lot of time actually reassuring patients who are either prediabetic or newly diagnosed but still well controlled that there is a lot we can do to prevent them from progressing to the long-term consequences if they take good care of themselves.”
She explains to them that altering their diet is not so difficult and mainly requires avoiding simple carbohydrates quickly absorbed into the blood stream. Good diet options include the Mediterranean and dietary approaches to stop hypertension (DASH) diets, which are similar in their focus on vegetables, fruit, whole-grain carbohydrates, and healthy protein.
She also prescribes a walking program to increase patient activity and often sees these patients when she is out getting her own exercise. Severely obese people with joint issues can try lower-impact exercises, such as walking in a swimming pool.
“There are huge benefits to patients if they improve their diet and increase their physical activity, and the benefits go well beyond just avoiding diabetes. Better diet and exercise also improve their cardiovascular outlook, mood, effectiveness at work, and all kinds of other aspects of their life,” Komives says.
“There is little to no downside. It is all about just trying to take good care of yourself.”