• Eva Tseng, Raquel C Greer, Paul O'Rourke, Hsin-Chieh Yeh, Maura M McGuire, Ann L Albright, Jill A Marsteller, Jeanne M Clark, and Nisa M Maruthur.
• Division of General Internal Medicine, The Johns Hopkins University, Baltimore, MD, USA. etseng3@jhmi.edu.
• J Gen Intern Med. 2019 Nov 1; 34 (11): 2475-2481.

BackgroundDespite strong evidence and national policy supporting type 2 diabetes prevention, little is known about type 2 diabetes prevention in the primary care setting.ObjectiveOur objective was to assess primary care physicians' knowledge and practice regarding perceived barriers and potential interventions to improving management of prediabetes.DesignCross-sectional mailed survey.ParticipantsNationally representative random sample of US primary care physicians (PCPs) identified from the American Medical Association Physician Masterfile.Main MeasuresWe assessed PCP knowledge, practice behaviors, and perceptions related to prediabetes. We performed chi-square and Fisher's exact tests to evaluate the association between PCP characteristics and the main survey outcomes.Key ResultsIn total, 298 (33%) eligible participants returned the survey. PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes. Only 36% of PCPs refer patients to a diabetes prevention lifestyle change program as their initial management approach, while 43% discuss starting metformin for prediabetes. PCPs believed that barriers to type 2 diabetes prevention are both at the individual level (e.g., patients' lack of motivation) and at the system level (e.g., lack of weight loss resources). PCPs reported that increased access to and insurance coverage of type 2 diabetes prevention programs and coordination of referral of patients to these resources would facilitate type 2 diabetes preventive efforts.ConclusionsAddressing gaps in PCP knowledge may improve the identification and management of people with prediabetes, but system-level changes are necessary to support type 2 diabetes prevention in the primary care setting.

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