Low Engagement in Diabetes Prevention Programs for High-Risk US Adults

A health care professional helping a diabetic man make healthy food choices to control his blood glucose levels.
Engagement in diabetes prevention programs is extremely low for US adults at high risk for type 2 diabetes.

Engagement in diabetes prevention programs is extremely low for adults in the United States at high risk for type 2 diabetes, according to study results published in JAMA Network Open. Guidance or referral from a healthcare professional was associated with a higher likelihood of participation in these lifestyle modification programs.

In the United States, there are several organizations focused on diabetes prevention services that aim to decrease the economic, physical, and psychosocial burden of the disease. Lifestyle changes and insulin-sensitizing medications may delay onset of diabetes in high-risk patients, thus the efforts of the diabetes prevention programs are aimed at applying these principles in community, workplace, healthcare, and online settings.

Using 2016 and 2017 National Health Interview Survey data, the largest nationally representative survey of noninstitutionalized US adults, researchers identified adults with prediabetes or at a high risk for diabetes according to the American Diabetes Association (ADA) composite risk score (≥5 indicated a high-risk score).

The researchers assessed the association of a prediabetes diagnosis or elevated ADA risk score with actions of a healthcare professional and participation in diabetes prevention activities, including dietary consultation, physical activity guidance, or referral to weight-loss programs. National diabetes prevention continuum diagrams generated by the researchers were used to assist with the identification of gaps in delivery and program uptake.

The analyses included 50,912 adults (mean age, 46.1; 48.1% men) without a known diagnosis of diabetes, representing 223 million US adults without diabetes in 2017. Of the represented population, approximately 80 million (36%) were at high risk for diabetes, including 17.9 million (22.2%) with known prediabetes, 73.3 million (91.9%) with an elevated ADA risk score, and 11.3 million (14.1%) with both.

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Advice from a healthcare professional and/or referral for diabetes risk reduction programs was reported by 73.5% of overweight patients with diagnosed prediabetes and 50.6% of overweight patients with elevated ADA risk score but without a diagnosis of prediabetes. Of participants who received any guidance in the past year from their healthcare professional, 35.0% to 75.8% of patients with known prediabetes and 33.5% to 75.2% of participants with elevated ADA risk score reported engaging in programs or activities in the past year.

Compared with patients who did not receive any guidance, engagement in diabetes risk reduction activities and/or programs was higher in participants receiving advice and/or referral from a healthcare professional (85.8% and 81.8% of patients with diagnosed prediabetes or elevated ADA risk score, respectively, vs 62.3% and 50.5%, respectively).

Greater engagement in risk reduction activities was evident in adults age 45 to 64, participants with hypertension or a history of gestational diabetes, more than a high school-level education, and of non-Hispanic black and Asian ethnicity. This was especially true in patients not advised or referred by a healthcare professional, indicating greater motivation in people with comorbidities or higher self-perceived risk.

The use of cross-sectional data that represents the activities and recall only at the time of the survey was one of the major limitations of the study. Self-reported data and limitations to the ADA risk score and the definitions of high risk for diabetes were additional study limitations.

“These data provide, to our knowledge, the most comprehensive assessment of the degree to which US adults who are likely to benefit from diabetes prevention services are undergoing testing, counseling, and actual engagement in risk-reduction activities and/or programs,” wrote the researchers.

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Ali MK, Bullard KM, Imperatore G, et al. Reach and use of diabetes prevention services in the United States, 2016-2017 [published online May 10, 2019]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2019.3160