Diabetes status report shows extremely low referral and engagement in prevention programs

May 10, 2019

A new study published in JAMA Network Open finds that 14.5 percent of patients with diagnosed prediabetes take medication to lower glucose, but less than five percent were referred to diabetes prevention programs nationally.

Adults with a prediabetes diagnosis were more likely to receive lifestyle modification advice or referrals to programs from their health care professionals than patients at high risk of diabetes who don’t have a formal diagnosis. Over 80 percent of those who received medical advice followed the suggestions of their provider adopted positive lifestyle changes in the previous year. Mohammed K. Ali, MD, MSc, MBA, associate professor at the Emory Rollins School of Public Health, led the study with colleagues at the Centers for Disease Control and Prevention (CDC).

“Our report is a wake-up call,” says Ali. “Seventeen years after the publication of trials showing that intensive lifestyle change programs for people with prediabetes can delay onset of type 2 diabetes by an average of seven years and lower other heart disease risk factors, nationally, less than 20 percent of people at risk of diabetes are referred to weight loss programs and less than five percent to designated diabetes prevention programs.”

The researchers analyzed data from the nationally representative, population-based cross-sectional National Health Interview Survey from 2016 and 2017, which included the responses of 50,912 nonpregnant individuals ages 18 or older representing 223 million American adults. Half of the 53.5 million overweight adults with high American Diabetes Association (ADA) risk scores, but no prediabetes diagnosis, received some form of risk reduction advice –for example, to eat a healthier diet, exercise regularly, enroll in a weight loss program, or attend a designated diabetes prevention program–  and of those, 33-75 percent followed their providers’ recommendations. Three-quarters of the 14.6 million overweight adults with a prediabetes diagnosis received some type of advice, and 35-76 percent reported following the guidance they received.

Those more likely to engage were women; minority races and ethnicities; more educated persons; insured persons; and adults with a history of gestational diabetes, hypertension or obesity. These findings highlight the gaps in the types and frequency of medical advice provided for U.S. adults at risk for type 2 diabetes. 

“Our report offers a range of findings and offers some optimism, perhaps over reporting, that people at high risk adhere to the advice given to them, but pessimism that they don’t recall receiving referrals to programs,” says Ali. “This latter finding may represent poor recall by those surveyed or may reflect that health care professionals are good at giving general dietary and physical activity advice, but are either not aware of, or have not bought into, the value of weight loss and diabetes prevention programs.

“These gaps are remediable and there are already initiatives being led by the American Medical Association, American Diabetes Association, and CDC to address them,” notes Ali. “The larger issue not reflected in this report is that engagement in behavior change is defined broadly here, and sustained behavior change is extremely challenging. Understanding and optimizing the psychological and economic motivations toward wellness and prevention represent the next frontier of population health in America.”