Primary Care's Role in Diabetes Prevention: John Anderson, MD

In primary care, the window to prevent or delay type 2 diabetes is often missed, despite regular patient contact and well-established screening tools. Moreover, cardiovascular risk begins accumulating in the prediabetes phase, even before patients meet formal diagnostic thresholds based on hemoglobin A_1C (HbA_1C) or fasting glucose.

John Anderson, MD, an internal medicine and diabetes specialist at the Frist Clinic and past president of Medicine & Science for the American Diabetes Association (ADA), underscored that primary care clinicians are “on the frontline,” with frequent opportunities to identify at-risk patients. Routine screening for fasting glucose and HbA_1C should be standard, and once pre-diabetes is identified, management must be aggressive rather than passive. Although there are currently no FDA-approved medications specifically for pre-diabetes, the evidence for lifestyle interventions is strong: achieving even a 5% to 7% reduction in body weight can substantially delay the onset of overt diabetes.

The treatment paradigm for newly diagnosed type 2 diabetes is also shifting. Historically, clinicians followed a “fail metformin first” approach before advancing to newer therapies. According to Anderson, that model is now outdated. For patients struggling with weight or those with cardiovascular or renal comorbidities, sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists should be considered from the outset. These agents not only lower glucose and A_1C but also promote weight loss and confer important cardiorenal benefits. In many cases, they should be introduced early and in combination.

The discussion also highlighted significant barriers to wider use of continuous glucose monitoring (CGM) in primary care. Beyond cost and coverage, a major obstacle is clinician familiarity—knowing how to obtain devices, initiate them, and integrate CGM data into routine practice. Historically, commercial and Medicare reimbursement often required recurrent hypoglycemia or insulin use.

However, the Anderson praised the ADA’s 2026 standards of care, which recommend CGM for any patient with diabetes for whom it could make a meaningful difference. Evidence shows that simply introducing CGM can lower HbA_1C, reduce weight, and drive profound behavior change. As Anderson noted, CGM is both a technology tool and a therapy, poised to reshape diabetes management in primary care.