title: Prediabetes Diagnosis and Treatment in Primary Care.
abstract: BACKGROUND
  The increasing prevalence of diabetes is a major health problem. The detection and treatment of prediabetes can delay the onset of diabetes and presents an important diabetes prevention strategy.
  
  
  METHODS
  Using data from the 2012 National Ambulatory Medical Care Survey, we studied visits by adults aged ≥45 years without diagnosed diabetes who had an HbA1c test within 90 days of the visit (n = 518 unweighted visits; n = 11,167,004 weighted visits). HbA1c results were categorized into normal, prediabetes, and diabetes, and we examined patient characteristics (age, sex, race, payer type, body mass index) and treatment of prediabetes.
  
  
  RESULTS
  Among visiting adults, 54.6% had a normal HbA1c value, 33.6% had prediabetes, and 11.9% had diabetes. Of those patient visits with HbA1c consistent with prediabetes, the number of patients diagnosed with prediabetes was too low for a reliable population estimate. Indication of treatment in the medical record (lifestyle modification counseling and/or metformin) was present in 23.0% of those with diagnosed or undiagnosed prediabetes. The most common treatment was lifestyle modification counseling.
  
  
  CONCLUSIONS
  Our findings show that there are missed opportunities for diabetes prevention in primary care. Providers need to change their approach to prediabetes and play a more effective role in preventing diabetes.
authors.affiliation: From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (AGM, RJT); the Department of Health Sciences, University of Leicester, Leicester, UK (RB). arch.mainous@ufl.edu.
authors.forename: Arch G
authors.initials: AG
authors.lastname: Mainous
authors.affiliation: From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (AGM, RJT); the Department of Health Sciences, University of Leicester, Leicester, UK (RB).
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Tanner
authors.affiliation: From the Department of Health Services Research, Management and Policy, University of Florida, Gainesville (AGM, RJT); the Department of Health Sciences, University of Leicester, Leicester, UK (RB).
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
mesh_terms: D000368:Aged; D003376:Counseling; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Diabetes Mellitus; Prediabetes; Primary Health Care