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What Are We Doing To Prevent Type 2 Diabetes?

Mar 24, 2018

Only 3.1% Americans engage in activities to prevent a diabetes diagnosis.

In the U.S., 12% of adults have type 2 diabetes, and over the past 25 years, prevalence has increased by 60% to 29 million individuals. 30% of the adults in the U.S. have prediabetes. However, there is a strong evidence base for interventions to prevent or delay type 2 diabetes among high-risk individuals. Large randomized controlled studies in China, Finland, the U.S., and India, among others, have shown that, among individuals with prediabetes, structured behavioral approaches to modifying lifestyles (exercising more and consuming more fiber but fewer total calories, fats, and sugar-sweetened beverages) lower type 2 diabetes incidence by 30–60%. Multiple studies have shown that there are long-term benefits of prevention behaviors, including greater likelihood of regression to normal blood sugars and fewer complications and cardiovascular deaths. Although prevention efforts for high-risk individuals (i.e., those with prediabetes) focus on structured lifestyle change programs to make and sustain these lifestyle behavior changes, efforts to reduce type 2 diabetes incidence may be optimized if population-wide changes in major dietary risk factors and physical activity levels are also achieved.

We know that diabetes in the U.S. is at epidemic proportions, but what percentage of those at risk are actually doing something to prevent diabetes?  So, this study looked at the proportion of American adults without type 2 diabetes who engage in lifestyle behaviors known to reduce type 2 diabetes risk.

Using a cross-sectional analysis of 3,679 nonpregnant, nonlactating individuals age ≥20 years without diabetes (self-reported diagnosis or glycated hemoglobin ≥6.5% [8 mmol/mol] or fasting plasma glucose ≥126 mg/dL) and who provided 2 days of reliable dietary data in the 2007-2012 National Health and Nutrition Examination Surveys (NHANES). They used the average of 2 days of dietary recall and self-reported leisure-time physical activity to assess whether participants met type 2 diabetes risk reduction goals (meeting four or more MyPlate recommendations [adequate consumption of fruits, vegetables, dairy, grains, meat, beans, and eggs]; not exceeding three maximum allowances for alcoholic beverages, added sugars, fat, and cholesterol; and meeting physical activity recommendations [≥150 min/week]).

This cross-sectional analysis assessed whether individuals without diabetes mellitus met type 2 diabetes risk-reduction goals. Participants provided 2 days of reliable dietary data and leisure-time physical activity in the 2007–2012 National Health and Nutrition Examination Surveys (NHANES). Among U.S. adults with prediabetes, a higher percentage were males, were older, had less than a college education, had excessive weight/obesity, were non-Hispanic black, and were smokers than in those without prediabetes. Approximately half of the participants consumed the recommended amount of total grains, 54.2% consumed recommended amounts of meat/beans, and 40.6% consumed recommended amounts of oils. Even fewer met the fruit and vegetable goals: 21% met fruit consumption goals and 29% met vegetable goals. Moreover, only about one-third (37.8%) met the physical activity goal and 58.6% met the weight loss/maintenance goal. Participants who were younger and less educated had a 56% to 73% lower probability of meeting the lifestyle goals.

Overall, only 3.1% of U.S. adults surveyed engaged in most of the recommended activities aimed at reducing the risk for type 2 diabetes.

The low percentages of individuals engaging in behaviors that could help reduce type 2 diabetes risk in this and the current study represent a large potential for improvement and type 2 diabetes risk reduction at the population level. For example, lifestyle interventions among individuals at high risk of developing type 2 diabetes patterned after the Diabetes Prevention Program (DPP), in which trained counselors coach consumers on healthier eating habits, increased physical activity, and stress reduction have been effective in diverse settings, including communities, workplaces, clinics, large health systems, and through online media.

From the results of the study it was concluded that only a small proportion of U.S. adults engage in risk-reduction behaviors. We need to do more interventions targeted at young and less-educated segments of the population, which could help close gaps in risk-reduction behaviors.

Certainly, one of the major obstacles in getting people to be more proactive in their care, is to first let them know they have prediabetes. Most of the 100 million people in the U.S. with prediabetes do not even know they have prediabetes. Getting an A1c screening test for this population could have a major impact in the prevention of getting diabetes.

Practice Pearls:

  • 30% of the adults in the U.S. have prediabetes.
  • A small proportion of U.S. adults engages in risk-reduction behaviors.
  • It is difficult to take steps to prevent diabetes if you do not know you have prediabetes.


Siegel, Karen R.; Bullard, Kai McKeever; Imperatore, Giuseppina; Ali, Mohammed K.; Albright, Ann; Mercado, Carla I.; Li, Rui and Edward W. Gregg. Prevalence of Major Behavioral Risk Factors for Type 2 Diabetes. Diabetes Care 2018 Mar; dc171775.