Prediabetes
The incidence of diabetes continues to rise annually in the country and the globe. The costs incurred by people diagnosed with this condition also continue to increase (Cowie, 2019). Patients incur expensive treatment regimens that they have to take throughout their lives to control risk factors like glycemia, visits to the health units, and hospitalization cases. The key to avoiding these costs is the early diagnosis of diabetes (Cowie, 2019). Prediabetes is a condition that signifies a high risk of diabetes. This condition manifests through blood glucose levels higher than the normal range of below 7.8 mmol/l. Prediabetes does not have any definite signs and symptoms apart from the darkening of the skin on the affected areas. Prediabetes has the probability of progressing to type 2 diabetes if the patient does not take advantage of interventions to control the condition. Prediabetes can also indicate the culmination of long-term damages of diabetes. Early detection, lifestyle changes, and medication can stop the condition from progressing to diabetes.
Diagnosis criteria
Diabetes and prediabetes tend to develop gradually and can be hard to detect in the early stages. The American Diabetes Association (ADA) has several guidelines to determine individuals who should undergo screening tests for these conditions (2. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2019,” 2018). These guidelines recommend that individuals with a body mass index higher than 25, women with gestational diabetes, those over the age of forty-five, and those who receive a diagnosis of prediabetes earlier should undergo a screening test. In addition, those at risk of developing prediabetes have other factors like cardiovascular diseases, hypertension, family history of close relatives with diabetes, ethnicity, and conditions that interrupt how the body uses insulin (Cowie, 2019). There are currently four types of screening tests available when screening for prediabetes and both types of diabetes; the random blood sugar test, glycated hemoglobin (A1C) test, oral glucose tolerance test, and fasting blood sugar test.
The random blood sugar test involves taking a blood sample randomly regardless of the patients eating schedule. The oral glucose test requires one to fast overnight before taking blood samples. The patient later consumes a sugary liquid, and the caregiver tests blood glues levels at two-hour intervals. Both these readings indicate the presence of prediabetes when blood glucose levels range up to 11.0 mmol/l or more (Cowie, 2019). The fasting blood sugar test also requires the patient to fast overnight before taking screening samples. Blood glucose levels ranging between 5.6 and 6.9 mmol/l indicate prediabetes, while 7mmol/l or higher indicates diabetes (Cowie, 2019). However, most of these conditions go unnoticed due to cases of physicians missing some stages when diagnosing prediabetes in health centers. A large portion of the primary health care providers in many parts either lack sufficient knowledge of the risk factors, the diagnosis process, or patient intervention methods (Mainous et al., 2022). Such is the case of most of the health units in sub-Saharan Africa.
Prediabetes Missed Diagnosis Opportunities Quantitative Studies
There are several studies that researchers have conducted to investigate the rate at which missed diagnosis of patients with prediabetes occurs. Researchers recently conducted a cross-sectional descriptive study of patients in West Africa to determine the number of missed opportunities for diabetes testing. The study includes analyses of male and female patients attending the General Outpatient Clinic, which is a tertiary health unit in the southwest of Nigeria, with approval from the Research Ethics Committee of Federal Medical Centre Abeokuta (Ojo et al., 2020). The country’s poor state of health care seems to cause much backlash on the tertiary health units. The study population includes members of both genders over the age of 18 years, meeting the study criteria for the research. The researchers also make sure to use a specific exclusion criterion to make sure the study results are accurate. Patients who were either pregnant, those previously diagnosed with diabetes mellitus, chronic medical conditions, and those who had previously undergone a blood glucose test in the last year were not viable to participate in the study (Ojo et al., 2020). The study also excludes patients who use drugs that can affect their blood glucose levels.
The study includes a total of 427 patients out of an average of 1168 patients attending the hospital in the month (Ojo et al., 2020). The criteria for selecting these patients were a random sampling technique making sure to obtain their consent. Then, the patients undergo the normal routine like getting vital signs examinations by nurses and checkups by the doctor before getting sent to the consultation room with the researchers. Next, patients who fit the criteria for the study are interviewed by the researchers using a pretested questionnaire that contains vital information such as the social demographic variables, physical examination, investigation, and guideline-recommended risk factors (Ojo et al., 2020). The information required for the social demographic section includes the patient’s age, gender, marital status, religion, ethnicity, and education level. The guideline risk factors in the questionnaire contain seven factors as the guideline for prediabetes in the area. These factors include their family history, a BMI more or equal to 25kg/m2, waist circumference, previous deliveries of fat babies, and gestational diabetes (Ojo et al., 2020). Other factors in this section include hypertension and age, either forty-five years or over.
The researchers in the study use a criterion with these seven factors to determine a missed opportunity for diabetes screening. A missed opportunity in this situation is mostly due to the doctor’s failure to screen patients for diabetes according to all factors. The researchers make sure to test the selected patients, taking readings of their blood pressure and anthropometric measurements on the first day before referring them to a definitive Diabetes mellitus test on the next day. Patients who choose to show up undergo fasting blood glucose (FBG) tests using a glucometer. Participants whose tests reveal an FBG equal to or more than 7mmol/ l receive a diagnosis of having diabetes mellitus, while those whose FBG ranges between 5.6 to 6.9 mmol/l receive a diagnosis of prediabetes. The researchers also make sure to send those high readings back to the laboratory for repeat tests that reveal the same diagnosis. Participants who fail to show up for the follow-up tests have their variables in the final conclusion for calculations.
Participants who receive these diagnoses receive counseling regarding lifestyle changes like their diet, exercising, and medication to help with their conditions. The whole study takes a total of four weeks to complete. At the end of the study, the researcher analyzes the data, classifying information such as social demographic factors into appropriate charts and tables, categorizing continuous variables into mean and standard deviations, and categorical variables into percentages. Then, the researchers calculate and record the number of those who receive new diagnoses. According to the study, the total number of participants who fail to show up for the follow-up tests together. The researchers also make sure to classify their factors into various categories. The research results reveal that out of the 427 participants, ten of the respondents fail to show up for follow-up tests.
This study reveals that many cases of prediabetes are often missed or ignored by primary caregivers. Physicians in this hospital setting fail to screen patients who manifest four or more of the factors in the guideline (Ojo et al., 2020). The study shows that over seventy percent of those found with diabetes or prediabetes are over the age of forty-five years. The respondents also manifest other risk factors such as cardiovascular conditions like hypertension patients (Jia et al., 2020). There were, however, difficulties in recording the sample size due to some limitations like inadequate research on this topic. The number of people who participate in this research is not enough to help get the magnitude of this problem.
However, the research design is efficient in this case as it reveals that there are multiple cases of missing diagnoses opportunities during the process of prediabetes screening. The researchers’ methods used to analyze the patients would also yield better results if the oral glucose tolerance test. This test does not require patients to fast overnight. It is also not easy to determine whether other participants follow the rules of overnight fasting for the FBG test. This type of test reveals how the body handles sugar in the body, making deductions of prediabetes more accurate. Questionnaires prove to be one of the best methods for gathering quantitative data in a hospital setting. This method is cheap, accurate, and helps researchers reach out to people fast. The researchers also have the opportunity to interact explain questions to the participants in case of any misunderstandings.
Conclusion
The continuous rise of people with a diagnosis around the globe suggests that more has to be carried out by healthcare providers to control the situation. Prediabetes is one of the prior stages of diabetes type 2. Early detection and interventions to prediabetes can help reduce the long-term effects of diabetes and prevent the condition from progressing to diabetes type 2. However, there are many reasons why people are not able to find out about their conditions, most of which are due to a lack of proper diagnosis. Primary health caregivers either skip steps during screening tests or do not know how to conduct diagnosis and recommend treatment. Since prediabetes does not usually show any symptoms, it is easy to miss the condition in patients. The research above accurately highlights this problem in the case of a hospital in Nigeria. There is still much to do to minimize missing diagnosis opportunities when screening for prediabetes.
References
2. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2019 | Diabetes care | American Diabetes Association. (n.d.). https://diabetesjournals.org/care/article/42/Supplement_1/S13/31150/2-Classification-and-Diagnosis-of-Diabetes
2. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2019. (2018). Diabetes Care, 42(Supplement_1), S13-S28. https://doi.org/10.2337/dc19-s002
Cowie, C. C. (2019). KELLY WEST AWARD LECTURE| MAY 10 2019 Diabetes Diagnosis and Control: Missed Opportunities to Improve Health : The 2018 Kelly West Award Lecture. Daibetes Care, 42(6), 994-1004. doi.org/10.2337/dci18-0047
Jia, H., Liu, L., Huo, G., Wang, R., Zhou, Y., & Yang, L. (2020). A qualitative study of the cognitive behavioral intention of patients with diabetes in rural China who have experienced delayed diagnosis and treatment. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-08636-2
Mainous, A. G., Rooks, B. J., Wright, R. U., Sumfest, J. M., & Carek, P. J. (2022). Diabetes prevention in a U.S. healthcare system: A portrait of missed opportunities. American Journal of Preventive Medicine, 62(1), 50-56. https://doi.org/10.1016/j.amepre.2021.06.018
Ojo, O. S., Egunjobi, A. O., Fatusin, A. J., Fatusin, B. B., Ojo, O. O., Ololade, F. A., Eruzegbua, P. A., Afolabi, O. A., & Adesokan, A. A. (2020). Magnitude of missed opportunities for prediabetes screening among non-diabetic adults attending the family practice clinic in western Nigeria: Implication for diabetes prevention. South African Family Practice, 62(1). https://doi.org/10.4102/safp.v62i1.5082
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