Woman, 58 years of age, history of PCOS, prediabetes, strong family history of type 2 diabetes, cardiovascular disease and obesity. This patient lives a healthy lifestyle, including a lower carb meal plan, is very active, and keeps her weight down. Those interventions did not lower her A1C, so she educated herself and asked her NP/CDE if she should start metformin. This was about 20 years ago. Since starting metformin, A1C is in the 5.1-5.5% range. Patient regularly checks glucose, which was recently rising. A1C rose to prediabetes range again. Started on GLP-1 by NP/CDE. Patient then went to a new PCP who told her she should not be taking metformin or the GLP-1 because she does not have diabetes. Wanted to refer her to an endocrinologist. Patient continued with her NP/CDE, metformin, GLP-1 and healthy lifestyle. Glucose levels for the most part back to less than prediabetes levels (fastings less than 100mg/dL, and post prandials <140mg/dL). Patient was not against going to endocrinologist, but had done enough study on her own to know her NP/CDE was right on. She stayed with her NP/CDE, but she decided to change PCPs to one she thinks better understands prediabetes, will work with patient and allow more shared decision making.
- The field of medicine is changing. Both patients and healthcare professionals besides physicians have the opportunity to be better informed than in the past.
- Just like type 2 diabetes, prediabetes is common, but not a condition that should be ignored or treated lightly. There are not enough endocrinologists in the U.S. to see every person who has prediabetes or type 2 diabetes. Healthcare providers need to keep up with current treatment and recommendations.
- Refer patients to diabetes education or provide the information they need to know to help them make informed decisions.
- Use the shared decision making process with your patients. This includes keeping yourself and your patients educated. It is our patients who live with their prediabetes or diabetes 24/7.
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