What to say to patients with pre-diabetes

Patients who have a high risk of developing diabetes should be educated about the effectiveness of regular physical activity and modest weight loss in slowing the progression to diabetes. Here are some educational issues to discuss with patients diagnosed with pre-diabetes:

• Never tell patients that they have “a little bit of diabetes” or “borderline diabetes.” Patients need to know that they have pre-diabetes, which already has an increased risk of mortality, but that they can do specific things to prevent progression to diabetes.
• Discuss the importance of smoking cessation as a strategy for helping to prevent cardiovascular complications.
• Stress that incremental changes are more long-lasting and effective than sudden, drastic changes in eating and exercise behaviors.
• Ask patients to choose a behavioral goal at the end of your discussion; for example: “Will you do anything between now and our next visit to help lower your risk for diabetes?”
• Refer for education and/or medical nutrition therapy. Some, but not all, insurance plans and managed care organizations offer reimbursement for education and medical nutrition counseling for the prevention of diabetes. Preparing by first clarifying reimbursement with the diabetes educator or common insurance plans in your area will facilitate referral.

From the ACP Diabetes Care Guide.