Impaired glucose tolerance: qualitative and quantitative study of general practitioners' knowledge and perceptions

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Abstract
Objective: To investigate general practitioners' knowledge of and attitudes to impaired glucose tolerance. Design: Mixed methodology qualitative and quantitative study with semistructured interviews, focus groups, and questionnaires. Setting: 34 general practitioners in five primary care groups in the north east of England. Results: All the general practitioners had knowledge of impaired glucose tolerance as a clinical entity, but they had little awareness of the clinical significance of impaired glucose tolerance and were uncertain about managing and following up these patients. Attitudes to screening were mixed and were associated with reservations about increased workload, concern about lack of resources, and pessimism about the effectiveness of lifestyle interventions. Some general practitioners felt strongly that screening patients for impaired glucose tolerance and subsequent lifestyle intervention medicalised an essentially social problem and that a health educational approach, involving schools and the media, should be adopted instead. A minority expressed a positive attitude towards a pharmacological approach. Conclusion: Awareness of impaired glucose tolerance needs to be raised, and guidelines for management are needed. General practitioners remain to be convinced that they have a role in attempting to reduce the incidence of type 2 diabetes by targeting interventions at patients with impaired glucose tolerance. What is already known on this topic Impaired glucose tolerance is common and carries a 50% risk of progression to type 2 diabetes within 10 years of diagnosis and a doubling of the risk of developing cardiovascular disease Lifestyle intervention can significantly reduce the progression to diabetes, although the evidence for reduction in cardiovascular disease is less compelling What this study adds Awareness of the clinical significance of impaired glucose tolerance among general practitioners is low General practitioners are uncertain how best to manage and follow up patients with established impaired glucose tolerance General practitioners are reluctant to screen patients for impaired glucose tolerance for a variety of reasons