Call for Increased Awareness, Identification of Prediabetes

From Heartwire
Lisa Nainggolan

March 4, 2010 (Atlanta, Georgia) — Less than 10% of adults in the US with prediabetes are aware that they are at high risk of developing diabetes, according to the first nationally representative survey of adults there [1]. Dr Linda S Geiss (Centers for Disease Control and Prevention, Atlanta, GA) and colleagues report their findings online March 2, 2010 in the American Journal of Preventive Medicine.

"We know from clinical trials that people at high risk of diabetes--blood sugar levels higher than normal but not high enough to be diabetic--can reduce their risk of diabetes through lifestyle modifications that include dietary changes, increased physical activity, and weight loss,"
"The first step in getting people to do something and getting lifestyle-modification programs into place is being able to efficiently identify people at risk and increase awareness of that risk."

Geiss and her colleagues found that almost 30% of the 1402 adults they surveyed from the 2005–2006 National Health and Nutrition Examination Survey had prediabetes, but only 7.3% were aware of it--that is, had been told they were "borderline" diabetic; had impaired glucose tolerance; had blood sugar higher than normal but not high enough to be called diabetes; or had a prediabetes condition.

Physician Advice to Change Behaviors Is Key

Although most people surveyed had actually seen a physician in the past year, only a third of the adults with prediabetes had received advice from healthcare professionals about improving behaviors.

But physician advice is key, says Geiss, because the proportion of people who actually tried to change their behavior was higher if they had been advised to do so by a healthcare professional.

Around 75% of people advised by a doctor to adopt healthier lifestyles had tried to do so, compared with around 50% of those surveyed overall, she noted. She cautions, however, that the data are self-reported, so this is a limitation of the study.

In multivariate analysis, in addition to healthcare provider advice, female gender and being overweight or obese were positively associated with all three risk-reduction behaviors: losing/controlling weight; reducing fat or calories in the diet; and increasing physical activity or exercise.

Reasons for physicians not providing advice could not be determined in this study, Geiss and colleagues note, but prior research suggests a number of reasons likely play a role. These include: lack of time and reimbursement for preventive services; poor physician training or insufficient knowledge of obesity management and nutrition; lack of understanding about successful strategies to help patients or of community resources; and the perceived futility of patients' efforts to make changes.

"One of the big issues is that physicians may not have adequate resources in the community to refer these folks to, because this is not a medical problem, it's a community-based problem," Geiss explains.

"In the US, we are trying to institute lifestyle-modification programs for people at risk. Diabetes has been really increasing over the past 20 years, and in order to reduce the incidence of disease we are going to have to get these people efficiently identified and into prevention programs," she concluded.

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