Cited by 156Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and EducationHealth Promotion and Cardiovascular Prevention

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Reach and use of diabetes prevention services in the United States, 2016-2017.

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Ali, Mohammed K., McKeever Bullard, Kai, Imperatore, Giuseppina, Benoit, Stephen R., Rolka, Deborah B., Albright, Ann L., Gregg, Edward W.·2019·JAMA Network Open

DOI 10.1001/jamanetworkopen.2019.3160PMC PMC6512285

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Abstract

Importance: Coordinated efforts by national organizations in the United States to implement evidence-based lifestyle modification programs are under way to reduce type 2 diabetes (hereinafter referred to as diabetes) and cardiovascular risks. Objective: To provide a status report on the reach and use of diabetes prevention services nationally. Design, Setting, and Participants: This nationally representative, population-based cross-sectional analysis of 2016 and 2017 National Health Interview Survey data was conducted from August 3, 2017, through November 15, 2018. Nonpregnant, noninstitutionalized, civilian respondents 18 years or older at high risk for diabetes, defined as those with no self-reported diabetes diagnosis but with diagnosed prediabetes or an elevated American Diabetes Association (ADA) risk score (>5), were included in the analysis. Analyses were conducted for adults with (and in sensitivity analyses, for those without) elevated body mass index. Main Outcomes and Measures: Absolute numbers and proportions of adults at high risk with elevated body mass index receiving advice about diet, physical activity guidance, referral to weight loss programs, referral to diabetes prevention programs, or any of these, and those affirming engagement in each (or any) activity in the past year were estimated. To identify where gaps exist, a prevention continuum diagram plotted existing vs desired goal achievement. Variation in risk-reducing activities by age, sex, race/ethnicity, educational attainment, insurance status, history of gestational diabetes mellitus, hypertension, or body mass index was also examined. Results: This analysis included 50 912 respondents (representing 223.0 million adults nationally) 18 years or older (mean [SE] age, 46.1 [0.2] years; 48.1% [0.3%] male) with complete data and no self-reported diabetes diagnosis by their health care professional. Of the represented population, 36.0% (80.0 million) had either a physician diagnosis of prediabetes (17.9 million), an elevated ADA risk score (73.3 million), or both (11.3 million). Among those with diagnosed prediabetes, 73.5% (95% CI, 71.6%-75.3%) reported receiving advice and/or referrals for diabetes risk reduction from their health care professional, and, of those, 35.0% (95% CI, 30.5%-39.8%) to 75.8% (95% CI, 73.2%-78.3%) reported engaging in the respective activity or program in the past year. Half of adults with elevated ADA risk scores but no diagnosed prediabetes (50.6%; 95% CI, 49.5%-51.8%) reported receiving risk-reduction advice and/or referral, of whom 33.5% (95% CI, 30.1%-37.0%) to 75.2% (95% CI, 73.4%-76.9%) reported engaging in activities and/or programs. Participation in diabetes prevention programs was exceedingly low. Advice from a health care professional, age range from 45 to 64 years, higher educational attainment, health insurance status, gestational diabetes mellitus, hypertension, and obesity were associated with higher engagement in risk-reducing activities and/or programs. Conclusions and Relevance: Among adults at high risk for diabetes, major gaps in receiving advice and/or referrals and engaging in diabetes risk-reduction activities and/or programs were noted. These results suggest that risk perception, health care professional referral and communication, and insurance coverage may be key levers to increase risk-reducing behaviors in US adults. These findings provide a benchmark from which to monitor future program availability and coverage, identification of prediabetes, and referral to and retention in programs.

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Authors: Ali, M. K., McKeever Bullard, K., Imperatore, G., Benoit, S. R., Rolka, D. B., Albright, A. L., & Gregg, E. W.
Affiliations: Centers for Disease Control and Prevention (US)
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Corresponding author: Ali, Mohammed K.
ORCID: Ali, Mohammed K.
Imperatore, Giuseppina
Benoit, Stephen R.
Rolka, Deborah B.
Gregg, Edward W.
Venue: JAMA Network Open
Publisher: American Medical Association (AMA)
Published: 2019-05-10
Volume: 2
Issue: 5
Pages: e193160
ISSN: 2574-3805 (ISSN-L)
DOI: 10.1001/jamanetworkopen.2019.3160
PMC: PMC6512285
OpenAlex: W2943880671
Cited by: 153
References: 46
Citations by year: 2026: 13 · 2025: 21 · 2024: 25 · 2023: 24 · 2022: 26 · 2021: 27 · 2020: 14 · 2019: 3
FWCI: 14.21
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JAMA Network Open (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Spiral (Imperial College London) (submittedVersion, cc-by)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords: type 2 diabetes prevention, prediabetes, Diabetes Prevention Program, lifestyle modification, physician referral, slimming program, exercise recommendations, dietary recommendations, body mass index, diabetes risk score, health care access disparities, health insurance status, cardiovascular risk reduction, United States adults
MeSH terms: Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Health Promotion, Health Surveys, Humans, Male, Middle Aged, Obesity, Prediabetic State, United States, Health Behavior, Case-Control Studies, Risk Reduction Behavior, Young Adult

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Reach and use of diabetes prevention services in the United States, 2016-2017.

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