|INITIAL PREDIABETES CONVERSATION: DOs & DON’Ts|
If a patient has been identified as having prediabetes, the leader of the health care team (physician, nurse practitioner, or physician assistant) should engage the patient in a discussion about the diagnosis and emphasize that evidence shows they can prevent or delay Type 2 diabetes by making specific lifestyle changes. Below are some recommended DOs and DON’Ts for this patient encounter:
|Do use the term prediabetes.||Don’t use the terms “borderline diabetes,” “touch of sugar,” or say the sugar is “a little high.”|
|Do ask for the patient’s questions, concerns, and feelings.||Don’t assume you know how the patient is reacting.|
|Do emphasize the significance of having prediabetes. Explain how this is different from type 2 diabetes, and offer hope for preventing or delaying the diagnosis of type 2 diabetes. Ask what questions or concerns the patient has.||Don’t assume all patients will understand this message in the same way. Some patients hear “diabetes” and experience immediate stress; others hear only “pre” and feel tremendous relief. Both of these reactions make it hard for a patient to listen and understand the remainder of your message.|
|Do tell the patient that having prediabetes means he or she has a much higher chance of developing type 2 diabetes in the coming years.||Don’t tell the patient it is just something to “keep an eye on” or monitor at the next visit. Conversely, don’t have a lengthy discussion about risk percentages, which is confusing to many people.|
|Do explain that he or she has a strong chance to prevent or delay type 2 diabetes by losing just a modest amount of weight (10 to 15 pounds), being more active, and, in some cases, taking medication.||Don’t tell the patient there isn’t much that can be done. Don’t say or imply that these changes are easy to make.|
|Do include older adults as a key target group, encouraging them to make manageable lifestyle changes to prevent diabetes.||Don’t assume older adults won’t make lifestyle changes or that older adults won’t experience the benefits of chronic illness prevention because of their advanced age. In the NIH-sponsored DPP, a greater percentage of older adults (> 60 years) made successful lifestyle changes and delayed diabetes onset compared with younger adults.|
|Do emphasize that the lifestyle change program used in the NIH-sponsored DPP was effective for all ages and ethnicities that participated.||Do not exclude groups that you think may not benefit as much, such as Asian Americans, American Indians, Alaska Natives, African Americans, or Hispanic/Latinos.|
|Do expect that people can change their behaviors no matter where they start.||Do not have pre-conceived ideas about an individual’s success in changing.|
|Do strongly encourage referral to another team member, community program, or other resource to assist each patient in ongoing steps to prevent type 2 diabetes.||Don’t tell the patient to lose weight and increase their physical activity without offering specific resources, behavioral strategies, support, and follow-up.|
|Do rely on the proven goals and intervention methods used in the NIH-sponsored DPP. For example, ask patients to identify one specific step they will take to reach their goals.||Don’t recommend unrealistic or ineffective goals.|
|Do use the “Teach-back” method to quickly assess a patient’s understanding.||Don’t assume the patient understands or simply ask “Do you understand?”|
NIH = National Institutes of Health; DPP = Diabetes Prevention Program
Adapted from the National Diabetes Education Program: A program of the National Institutes of Health and the Centers for Disease Control and Prevention. http://ndep.nih.gov/index.aspx.
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