Despite 1 in 3 American adults having prediabetes, only 11% report being told that they have prediabetes, according to researchers from the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC). The finding comes from an analysis of 3 sampling cycles of the National Health and Nutrition Examination Surveys (NHANES).
“Persons with prediabetes, including persons with regular access to health care, might benefit from efforts aimed at making them aware that they are at risk for developing type 2 diabetes and that they can reduce that risk by making modest lifestyle changes,” recommend the authors of the report, which appears in Morbidity and Mortality Weekly Report (March 22, 2013/62:209-212).
The analysis used data from the 2005-2006, 2007-2008, and 2009-2010 NHANES, from which 2,603 persons with prediabetes were identified from 6,771 valid values for fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c). Prediabetes is defined as an FPG of 100 to 125 mg/dL or an HbA1c value of 5.7% to 6.4%. When asked if they had ever been told by a doctor that they prediabetes, borderline diabetes, impaired fasting glucose, impaired glucose intolerance, or that their blood sugar was higher than normal but not high enough to be called diabetes, only 11.1% responded “yes.”
Although awareness was low across all subgroups analyzed, overweight and obese people were more likely to be aware of their prediabetes than those of normal weight (levels of awareness were 7.9% vs. 9.9% vs. 4.3%, respectively, in these groups). Those with a family history of diabetes were also more likely to be aware of their prediabetes compared with those without a family history (10.4% vs. 6.2%), as were those who reported taking either hypertension or hypercholesterolemia medication compared with those not taking such medication (13.9% vs. 6.1%), those with health insurance at the time of the interview compared with those without coverage (8.4% vs. 4.7%), those reporting a clinic or a doctor as a usual source of care compared with those without a usual source of care (8.9% vs. 4.4%), and persons who visited physicians more than once during the past 12 months compared with fewer than 2 visits (9.0% vs. 5.4%).
According to report co-author Yanfeng Li, MD, several factors may contribute to Americans’ low level of awareness of prediabetes. Physicians may not inform patients due to lack of time and reimbursement for preventive services and they may lack training or knowledge of obesity management and nutrition, she indicated in an e-mail correspondence with Diabetes E-Perspectives. Other factors that can influence low levels of physician advice may be a lack of knowledge of successful strategies to help patients or unfamiliarity with community resources available to help, and a perceived futility of patients’ efforts to make changes.
Patients may also be confused by different terms that their physicians use.
Risk factors for prediabetes and type 2 diabetes include ≥45 years; being overweight or obese; having a family history of diabetes; being of African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander race/ethnicity; having given birth to a baby weighing ≥9 pounds (4,082 g) or having a history of gestational diabetes; and being physically active <3 times a week, according to CDC.
“Physicians should talk to people with risk factors, including people aged 45 years and older, or those who are overweight or obese and have other risk factors,” said Dr. Li. “They should get them tested, inform them if they have prediabetes, and refer them to community-based type 2 diabetes prevention programs such as the National Diabetes Prevention Program for assistance.”
About one-third of persons with prediabetes will develop diabetes over the course of a decade.