Awareness of Prediabetes in the US is Low

Fran Lowry

March 27, 2013

According to the latest statistics, about 1 in 3 US adults 20 years and older have prediabetes, but only 11% are aware of their status.

The finding is reported online March 22 in Morbidity and Mortality Weekly Report.

Awareness of prediabetes was low, "regardless of education level, income level, coverage by health insurance or other kind of healthcare plan, or healthcare use," write YanFeng Li, MD, from the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and colleagues.

During 2005 – 2006, only 7% of US adults were aware that they had prediabetes. In this report, Dr. Li and colleagues sought to determine whether this awareness had increased in 2009 – 2010.

They analyzed data from the National Health and Nutrition Examination Survey (NHANES), sample of the noninstitutionalized US civilian population, for 3 time periods: 2005 – 2006, in which the examination response rate was 77%; 2007 – 2008, in which the examination response rate was 75%; and 2009 – 2010, in which the examination response rate was 77%.

The researchers identified 2603 participants with prediabetes, as defined as fasting plasma glucose (FPG) 100 to 125 mg/dL or glycated hemoglobin (HbA1c) of 5.7% to 6.4%.

They compared the prevalence of prediabetes awareness across a variety of factors, including age, race or ethnicity, sex, education level, poverty-to-income ratio, access to healthcare, having health insurance or other healthcare coverage at the time of interview, number of doctor visits in the past year, and having a usual source of healthcare such as a doctor's office or health clinic.

They also asked about family history of diabetes, use of medication for hypertension or hypercholesterolemia, and body mass index.

The analysis showed that the percentage of persons with prediabetes who were aware of their status was slightly higher in 2009 – 2010 than it was in 2005 – 2006 (P = .04), although the awareness remained low.

Specifically, the prevalence of awareness was lower among younger (aged 20 – 44 years; 5.1%) compared with people aged 45 to 64 years (10%) and those aged 65 years and older (11.9%) (P < .002 for both comparisons).

People with less than a high school education were less aware of their status than those with more than a high school education (prevalence 4.9% vs 8.7%; P = .003).

Normal-weight individuals were less aware of their status (prevalence 4.3%) compared with overweight (prevalence 7.9%, P = .045) and obese (9.9%, P = .004) individuals.

Awareness was also higher among those with a family history of diabetes compared with those without (10.4% vs 6.2%, P = .001), among those taking hypertension or hypercholesterolemia medication compared with those not taking such medication (13.9% vs 6.1%, P = .01), among those with health insurance or other coverage compared with those without (8.4% vs 4.7%, P = .008), and in people who reported having a usual source of healthcare that was either a clinic or doctor's office compared with those with no usual source (8.9% vs 4.4%, P = .01).

An editorial note points out that the findings in the report are subject to limitations. These include the fact that NHANES participants with impaired glucose tolerance were not included in the definition of prediabetes. "Had they been included, the overall estimate of awareness during 2009 – 2010 would have been 10.0% rather than 11.1%."

Other limitations include that the data on prediabetes awareness were self-reported and might be subject to recall bias as a result, the exclusion of military personnel and persons in nursing homes, the fact that the response rate to the surveys was about 75%, and the variability of the laboratory tests that were used in the analysis.

Despite these limitations, the fact remains that the prevalence of type 2 diabetes is increasing in the United States and that the disease can be prevented or delayed among those at high risk "by modest weight loss, good nutritional practices, and increased physical activity."

The note concludes by calling for improved identification and awareness of prediabetes. These are "critical first steps to encourage those with prediabetes to make healthy lifestyle changes or to enroll in evidence-based, lifestyle-change programs aimed at preventing type 2 diabetes."

Dr. YanFeng Li and colleagues report no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. Published onlineMarch 22, 2013. Full article