Uncertainty and certainty: perceptions and experiences of prediabetes in New Zealand primary care – a qualitative study

Abstract

Introduction Prediabetes is the asymptomatic precursor to type two diabetes mellitus, a significant and growing public health problem in New Zealand (NZ). Little is known about how general practitioners (GPs) and nurses view prediabetes care, and similarly little is known about how people with prediabetes view their condition and care. Aim This study aimed to investigate the views of NZ GPs and nurses, and people with prediabetes about prediabetes and its management. Methods This was a mixed qualitative methods study that is part of a randomised control trial of a prediabetes intervention. Results Three key themes emerged from the health professional data (GPs and nurses) and another three themes emerged from people with prediabetes data. GPs and nurses were uncertain about the progression of prediabetes; they felt prediabetes was not a priority and they were unsure about what to advise. People with prediabetes were uncertain about the diagnosis and information given to them; they were unsure about what to do about prediabetes and they found lifestyle change hard. Discussion GPs, nurses and people with prediabetes, expressed much uncertainty, but also some certainty about prediabetes. All were certain that prediabetes is common and increasing and that sustained lifestyle change was very difficult. But uncertainty prevailed about whether, in reality, prediabetes could be stopped, who would be most likely to benefit from lifestyle interventions and how best to achieve these. Older Māori and Pacific women were keen to promote lifestyle change and this appeared best done through Māori and Pacific peoples’ organisations by means of co-designed interventions.

A multiple case study of pre-diabetes care undertaken by general practice in Aotearoa/New Zealand: de-incentivised and de-prioritised work

“…However, a proportion of these people will never develop T2DM, and some will naturally revert to normoglycaemia. Clinicians in this study were concerned about the inability to identify and target those who most need pre-diabetes care [ 82 , 83 ]. In NZ and likely in other counties, improved risk stratification is needed.…”

They’re sicker than we think: an exploratory study profiling the cardio-metabolic health in a sample of adults with pre-diabetes in Aotearoa New Zealand

“…Pre-diabetes identifies individuals who are likely to be at risk for developing T2DM; however, its importance is controversial, [4][5][6] as not all with pre-diabetes will develop T2DM. 7 The primary care health professionals interviewed as part of a qualitative component of an intervention trial 8 repeatedly expressed uncertainty about who with pre-diabetes would best benefit from active intervention and at what stage. NZ uses a glycated haemoglobin (HbA 1c ) of 41-49 mmol/mol to classify pre-diabetes.…”

It is time for a more targeted approach to prediabetes in primary care in Aotearoa New Zealand

“…3 In NZ, primary care clinicians identify uncertainties about who is most likely to progress to T2DM and question when and how to intervene effectively. 13,14 They struggle to fit prediabetes care into time-constrained appointments. 13,14 Finding effective responses to these issues is critical for effective diabetes prevention and health equity.…”

“…13,14 They struggle to fit prediabetes care into time-constrained appointments. 13,14 Finding effective responses to these issues is critical for effective diabetes prevention and health equity.…”