Exclusive Interview with the Researcher: Dan Ly, MD, PhD, on Diabetes Preventive Therapies

Over 115 million American adults – more than 2 in 5 – have prediabetes, a condition that increases the risk of developing type 2 diabetes. A recent NIHCM-funded study, conducted by Dan Ly and team, examined racial and ethnic variation in the use of evidence-based type 2 diabetes preventive therapies and the progression from prediabetes to diabetes among US Veterans. Their findings note disparities in preventive therapy uptake and rates of disease progression. Learn more about this Journal of General Internal Medicine publication and the importance of its findings in this interview: 

Q: What surprised you the most about your findings?

A: I was surprised by the high rates of progression to diabetes across all Veterans with prediabetes—about a fifth to a quarter of all Veterans with prediabetes subsequently developed diabetes over the decade we examined.

Q: What do you think is driving the low uptake of evidence-based diabetes prevention among Veterans?

A: I think these are barriers not unique to Veterans in the Veterans Affairs (VA) health care system. Low uptake of such diabetes preventive therapies has been found in non-VA settings. Barriers may include lower awareness among both clinicians and patients of the probability of developing diabetes for patients with prediabetes, and hesitancy among patients and providers to start medications for such a condition.

Q: What implications might these findings have for health care utilization and cost, especially with the high progression of diabetes?

A: Given this relatively high probability of developing diabetes among Veterans and its often deleterious consequences and attendant costs, health care systems should make additional efforts to implement known effective diabetes prevention therapies and study other possible therapies.

Q: How might these findings inform efforts to improve diabetes prevention and management for both Veterans and the broader population?

A: Many health care systems care for a high proportion of patients with prediabetes. Knowing that their patients with prediabetes may be underutilizing evidence-based therapies and that they are at high risk of developing diabetes may motivate efforts to better understand the barriers to delivering high-quality care to their patients.

Q: What should policymakers and health care leaders take away from this analysis?

A: That prediabetes is prevalent and can often lead to diabetes—a condition associated with high costs and high morbidity. Furthermore, known strategies to reduce the risk of developing diabetes are not being used.

This analysis is supported by a NIHCM Policy Research Grant.