There is a large body of evidence showing behaviors that can raise, or lower, the risk of developing type 2 diabetes, especially in people at elevated risk for the condition — behaviors like getting more physical activity and cutting out processed and fried foods, for example. But even when they’re aware of a higher risk for developing diabetes, people are unlikely to adopt such changes, according to a new study published in the Journal of the American Board of Family Medicine.
Researchers looked at data from the 2015 and 2016 National Health and Nutrition Examination Survey (NHANES), which aims to be a representative survey of the community-dwelling (not institutionalized) U.S. population. Survey participants completed an interview at their home and underwent a physical exam and lab tests in a mobile examination center. Based on the results of their exam and lab tests, as well as answers to interview questions, certain participants were included in the latest study.
Diabetes risk awareness
One group, known as the prediabetes-aware group, included 389 people who had been told by their healthcare provider that they had prediabetes. The other group, the prediabetes-unaware group, included 410 people with a measured A1C level (a marker of long-term blood glucose control) between 5.7% and 6.4% who hadn’t been told they had prediabetes.
The researchers were interested in whether members of the two groups — those who were aware of their prediabetes, and those who were unaware — had a different outlook on their health and the need to adopt healthy behaviors to reduce their diabetes risk. They looked at four different questions in the NHANES survey: “feeling at risk for developing diabetes, self-reported general health status, self-reported perception of weight, and desire to lose weight.” They were also interested in whether actual behaviors were different between the two groups, looking at participants’ responses to 17 questions on dietary behaviors and physical activity.
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Impact on perceptions
There were no major differences in A1C level, body-mass index (BMI, a measure of weight that take height into account), racial or ethnic makeup, or education levels between the two groups. But members of the prediabetes-aware group were more likely to be women and to have health insurance, a routine place where they get healthcare, and a blood test for diabetes within the last three years.
There were notable differences in how members of the two groups perceived their health. While 67.1% of those in the prediabetes-aware group felt they could be at risk for diabetes, only 24.9% of those in the prediabetes-unaware group said the same. And while 32.2% of those in the prediabetes-aware group said their health was excellent or very good, 41.4% of those in the prediabetes-unaware group said this.
Even though there were no overall differences in body weight between the two groups, 69.3% of those in the prediabetes-aware group considered themselves overweight, while only 51.4% of those in the prediabetes-unaware group said the same. And while 51.5% of those in the prediabetes-aware group said they had tried to lose weight in the last year, only 35.3% of those in the prediabetes-unaware group said the same.
Impact on behaviors
There were far fewer meaningful differences between the two groups, though, in reported dietary and exercise behaviors. In fact, the answers to all seven questions on dietary behaviors were statistically the same between the two groups, covering topics such as how healthy participants perceived their diet to be, how often they ate food not prepared at home, how often that food was fast food or pizza, and whether they had heard of or tried following the federal MyPlate nutrition recommendations.
Answers to questions about physical activity were barely any different between the two groups, with those in the prediabetes-aware group actually reporting spending less time doing moderate physical activity on a typical day than those in the prediabetes-unaware group. There were no significant differences in self-reported walking or biking (for travel or leisure), vigorous activity or time spent sitting on a typical day.
The researchers concluded that people who were aware of their prediabetes status were more likely to feel at risk for diabetes, and to rate their health as being worse than those who were unaware of their prediabetes. But despite this awareness of their diabetes risk, “participants did not report increased engagement in health behaviors,” the researchers wrote. “This may be due to a lack of perceived severity of diabetes, a lack of self efficacy, a lack of benefits to action, significant barriers to action, a lack of cues to action, or social factors.”
More research is needed, the researchers wrote, to understand what factors affect how likely people with prediabetes are to adopt healthy behaviors to reduce their diabetes risk.