A critical realist exploration of health professionals’ perspectives on prediabetes diagnosis, management and type 2 diabetes prevention programs in a rural setting

Background People with prediabetes are at high risk of developing type 2 diabetes; therefore, diagnosing and managing this condition is critical. This qualitative study aimed to explore perspectives of health professionals with experience in prediabetes management in a rural setting about prediabetes diagnostic and management practices, to inform recommendations to improve type 2 diabetes prevention strategies and programs. Methods The study adopted a critical realist methodology. Nineteen health professionals from northern New South Wales, Australia, who were responsible for diagnosing and/or managing people with prediabetes were interviewed. Data were thematically analysed using a critical realist lens, then context–mechanism–outcome statements were generated and confirmed by co-authors using a discussion and reflection process. Results Five themes were generated from the semi-structured interviews: (1) the diagnostic dilemma; (2) care coordination and referral processes; (3) diabetes ‘waiting room’; (4) the spectrum of prediabetes management; and (5) blueprint for type 2 diabetes prevention. Conclusions Prediabetes is a complex condition requiring diagnosis and management by a multidisciplinary team of health professionals to delay and/or prevent progression to type 2 diabetes. Establishing clear roles and responsibilities for diagnosing and managing prediabetes, and development of strategies to improve referral to and engagement in type 2 diabetes prevention programs will improve prediabetes care and diabetes prevention in rural settings.