Research Article
Awareness of Prediabetes and Engagement in Diabetes Risk–Reducing Behaviors

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Introduction

Studies have demonstrated the benefit of weight loss and physical activity for diabetes prevention among those with prediabetes. Despite this evidence, only about half of people with prediabetes report engaging in these behaviors. One presumed barrier is low patient awareness of prediabetes. The purpose of this study is to examine the impact of prediabetes awareness on the odds of engagement in diabetes risk–reduction behaviors.

Methods

A pooled cross-sectional analysis of adults from two cycles (2007–2008, 2009–2010) of the National Health and Nutrition Examination Survey was conducted. Those with prediabetes were identified by excluding people with self-reported diabetes and then screening for hemoglobin A1c values between 5.7% and 6.4%. This group was then divided based on self-reported prediabetes. Multivariate logistic regression was used to estimate the effect of prediabetes awareness on the odds of engagement in physical activity, weight management, and the combination of physical activity and weight management.

Results

Of those meeting the defined criteria for prediabetes (n=2,694), only 11.8% (n=288) were aware of their status. Prediabetes-aware individuals had higher odds of engagement in the combination of moderate physical activity plus BMI-appropriate weight management (AOR=1.5, 95% CI=1.1, 2.0), and the combination of at least 150 minutes/week of moderate activity and 7% weight loss in the past year (AOR=2.4, 95% CI=1.1, 5.6).

Conclusions

Prediabetes-aware adults have increased odds of engagement in physical activity and weight management. Increasing patients’ awareness of prediabetes could result in increased performance of exercise and weight management behaviors and, most importantly, decreased risk of future diabetes.

Introduction

Approximately 86 million adults, or 37% of the U.S. adult population, meet the diagnostic criteria for prediabetes.1 Every year, 11% of people with prediabetes go on to develop diabetes.2 Multiple studies2, 3, 4, 5 have demonstrated the benefit of lifestyle modification, specifically modest weight loss and increased physical activity, in reducing the incidence of diabetes. The largest study was the Diabetes Prevention Program (DPP), an RCT that randomized overweight individuals into one of three arms: placebo, metformin, or lifestyle intervention. The lifestyle arm, which had an intervention goal of at least 150 minutes/week of moderate physical activity and a goal weight loss of ≥7% body weight, demonstrated a 58% decrease in the incidence of diabetes over 3 years and a 34% reduction at 10-year follow-up.2, 6 Importantly, these results have also been replicated in diabetes prevention programs in healthcare and community settings.7, 8, 9, 10, 11, 12

Despite this evidence, only half of those with prediabetes report engaging in risk-reduction behaviors.13 Additionally, it is unknown how many of these individuals achieve the targets shown to be of benefit by the DPP. One potential barrier to higher engagement rates is that awareness of prediabetes, although increasing, remains low, with only 11% of adults aware of their diagnosis.14 Willingness to perform a health behavior depends on the perceived need for action; thus, patients who are unaware of their diagnosis may lack the impetus to engage in risk-reduction behaviors.15 It is currently unknown whether awareness of prediabetes is associated with the increased performance of healthy behaviors.

In this study, nationally representative data are used to (1) assess differences in demographics, health care, and intermediate health outcomes between individuals who are aware and unaware of having prediabetes and (2) to examine the association between awareness of prediabetes and the performance of diabetes risk–reducing behaviors, specifically physical activity and weight management.

Section snippets

Methods

A pooled cross-sectional analysis from two consecutive cycles (2007–2008 and 2009–2010) of the National Health and Nutrition Examination Survey (NHANES) was conducted to investigate whether adults with prediabetes aware of their diagnosis were more likely to report engaging in diabetes risk–reducing behaviors than adults who were unaware of their diagnosis.

Results

A total of 2,694 participants met criteria for prediabetes. Of this group, 11.8% (n=288) were aware of this diagnosis (Figure 1). Those who were aware of prediabetes differed significantly from those who were unaware by age (57.6 vs 55.3 years, p=0.02) and educational attainment (p=0.04), but did not differ based on gender, income, or ethnicity (Table 1). Participants aware of prediabetes were less likely to have had no healthcare visits in the past year (5.9% vs 13.6%, p<0.001) and had a

Discussion

In this analysis of a large nationally representative sample performed between 2007 and 2010, only 11.8% of patients with HbA1c-diagnosed prediabetes were aware of their diagnosis. Regardless of this knowledge, engagement in both moderate or vigorous physical activity and BMI-appropriate weight management was uncommon in our study. Awareness of prediabetes was associated with an increased likelihood of engaging in the combination of physical activity and weight management efforts, but very few

Acknowledgments

All authors listed on the title page met the criterion for authorship based on the Committee on Publication Ethics guidelines. AG, ISL, and SCM contributed to study design, AG performed the data analysis, CW assisted with the programming used for the data analysis, SCM oversaw the statistical analysis, ISL and JAL provided content expertise and contributed to discussion, AG wrote the manuscript, ISL, CW, SCM, and JAL reviewed/edited the manuscript, and JAL is the guarantor of this study and

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