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Prevalence of Behavioral Risk Factors for Type 2 Diabetes

May 26, 2018

Behavioral risk factors for type 2 diabetes are widespread, with a very small proportion of U.S. adults engaging in risk reduction behaviors like proper diet and exercise for type 2 diabetes.  

The prevalence of type 2 diabetes has been increasing over the past 25 years. There is strong evidence that type 2 diabetes can be prevented or delayed in those who are at high risk. Studies have shown that modifying lifestyle by exercising more, and consuming more fiber and fewer calories and sugar-sweetened beverages can lower type 2 diabetes incidence in patients who have prediabetes. Thje prevention of type 2 diabetes has many advantages, including reduction in cardiovascular deaths and preventing eyes and kidney complications.

According to the American Diabetes Association (ADA) Standards of Care, the consumption of a low-calorie diet, whole grains, nuts, berries, yogurt, vegetables, fruits, fish, poultry, and tea can lower type 2 diabetes risk. A diet with high amounts of red meat, high-fat diary, processed foods, and sugar-sweetened beverages should be avoided as they increase the risk of type 2 diabetes. This study examined American adults >20 years of age meeting lifestyle goals for type 2 diabetes risk reduction and observed what proportion of individuals who met lifestyle goals developed diabetes.

The data for this study was used from the National Health and Nutritional Examination Surveys from 2007-2012: it was a continuous, cross-sectional survey of 3,679 individuals. The study population included non-pregnant, non-lactating individuals >20 years of age without diabetes and A1C <6.5% and fasting glucose <126 mg/dL. The type 2 diabetes risk reduction lifestyle goals were defined as meeting dietary, physical activity, and weight loss/maintenance recommendations. The U.S. Diabetes Prevention Program (DPP) and MyPlate diet guidelines were recommended in order to reduce total fat and calorie consumption and increase the intake of more whole grains, beans, meat, eggs, fruits, and vegetables. Physical activity was measured in minutes of moderate to vigorous-intensity leisure-time physical activity per week (>150 mins/week), insufficiently active (10-150 min) and inactive (<10 mins). The weight goal was defined as having a BMI in the normal range (18.5-25 kg/m2) or having excess weight or obesity, having tried to lose weight in past 12 months or have lost >5% body weight over last year.

In this study, the mean age was 46.3 years and almost half (47.7%) of the population was male. A higher percentage of the population who had prediabetes was older, had less than a college education, had excess weight or obesity, were non-Hispanic or Black, and were smokers compared to the population without prediabetes.

Approximately 21%, 29%, 13%, and 18% of the population without diabetes met fruit, vegetable, dairy and whole grain goals, respectively. In addition, about 50% of the enrolled adults met the meat and beans goal and about one-third met the physical activity goal. It was also found that fewer adults with prediabetes (31.7%) compared to adults without prediabetes (42.3%) met the goals. Regardless of their prediabetes status, only about 7% of the adults who had excess weight or obesity adults met the weight loss goals. About 24.1%, 42.7%, and 33.7% of adults without diabetes kept their consumption of sugars, saturated fats, and total fat under maximum allowance, respectively. The majority of the studied population were within daily limits of alcohol intake. It was found that people ages 20-44 and people with less than a high school education were less likely to meet the goals. In terms of achievement of goals, statistically non-significant results were found in sex, race, ethnicity, obesity status, hypertension, dyslipidemia, and smoking status.

Overall, results of this study found that only 3.1% of the adults without diabetes met the majority of the type 2 diabetes risk reduction goals. Findings of this study can conclude that many Americans do not consume a healthy diet or exercise enough, contributing to comorbid conditions, death, and disability. Diet and exercise are very important for individuals diagnosed with prediabetes as it can slow the progress to type 2 diabetes.

In conclusion, ecological evidence shows that lower availability of sugars/sweeteners and higher availability of fruits, vegetables, and whole grains can reduce the prevalence of type 2 diabetes in the U.S. Moderate to vigorous physical activity of greater than 150 mins a week can also help reduce risk of type 2 diabetes.

Practice Pearls:

  • A very small percentage of American adults without diabetes meet the type 2 diabetes risk reduction goals of diet and exercise.
  • Participants of a younger age and lower education had lower probability of meeting diet and exercise goals.
  • About 21%, 29%, and 13% of participants met fruit, vegetable, and diary goals, respectively. About 38% met physical activity goal and little more than half participants met weight loss goal.


Siegel K, Bullard K, Imperatore G et al. Prevalence of Major Behavioral Risk Factors for Type 2 Diabetes. Diabetes Care. 2018.


Vidhi Patel, Pharm. D. Candidate 2018, LECOM School of Pharmacy