Gaps Found in Diabetes Prevention Advice, Activities

Miriam E. Tucker

May 13, 2019

Diabetes prevention measures are under-utilized in the United States, new data suggest. 

The findings, from the 2016 and 2017 National Health Interview Survey, were published online May 10 in JAMA Network Open by Mohammed K. Ali, MD, of the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues.

Both the US Preventive Services Task Force and American Diabetes Association recommend screening and lifestyle counseling to achieve weight loss and reduce diabetes risk in high-risk adults. And diabetes prevention programs are covered under Medicare, many commercial health plans, and some Medicaid and state employee health plans.

Yet, Ali and colleagues found major gaps in provision of advice and referrals for diabetes prevention for adults at increased risk for type 2 diabetes, and low levels of patient engagement in diabetes risk-reduction activities or programs. 

"Risk perception, healthcare professional referral and communication, and insurance coverage may be key levers to increase risk-reducing behaviors in US adults," the investigators write. "To improve reach and use of diabetes preventive services, expansion of some combination of programs (supply), awareness (demand), and access and referrals by healthcare professionals (linkage) appears to be needed."

The study sample included 50,912 adults, representing about 223 million US adults.

Of those, 36.0% (representing 80 million adults) had either a physician diagnosis of prediabetes or a score higher than 5 on the American Diabetes Association (ADA) risk test or both.

Among an estimated 14.6 million adults with an elevated body mass index (BMI) and diagnosed prediabetes, 73.5% reported receiving any guidance in the past year from their healthcare professional about activities and/or programs to lower diabetes risk, including advice to increase physical activity (63%), reduce fat or calories (59.2%), or participate in a weight-loss program (21.3%).

Just 4.9% reported being referred specifically to a diabetes prevention lifestyle management program.

Among those who did receive the advice or referral, 70.0% increased physical activity, 75.8% reduced dietary fat or calories, 35.0% participated in weight-loss programs, and 39.6% participated in diabetes prevention programs. In addition, 14.5% reported taking medication to lower blood glucose levels.

In contrast, the estimated 53.5 million adults with high BMI and high ADA risk score but no specific diagnosis of prediabetes were less likely to receive advice or referrals for prevention. Specifically, just half (50.6%) reported receiving any diabetes risk-reduction advice or referral and less than 1% (0.4%) reported referral to diabetes prevention programs.

But when they were advised or referred, those high-risk individuals were as likely to participate as those with a prediabetes diagnosis, with 66.5% increasing their physical activity, 75.2% reducing dietary fat or calories, 33.5% participating in weight loss programs, and 40.4% participating in diabetes prevention programs.

Across groups, greater engagement in these programs was generally seen for adults aged 45 to 64 years, non-Hispanic black and Asian adults, individuals with hypertension, women with a history of gestational diabetes, and individuals with more than a high school education.  

Ali and colleagues write, "Our study offers a first assessment of participant-reported advice and/or referral by their healthcare professionals and engagement by adults at high risk using a national diabetes prevention continuum, demonstrating where the gaps occur, providing insights into possible policy and program actions, and providing a benchmark for future population-level monitoring."

The study was supported in part by the Georgia Center for Diabetes Translation Research, funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The authors have reported no relevant financial relationships.

JAMA Netw Open. 2019;2:e193160. Full text

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