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Increased awareness, unchanged behavior follow prediabetes diagnosis in Hispanic women

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February 8, 2019

Hispanic women with diagnosed prediabetes were no more likely to report making lifestyle changes to prevent the development of type 2 diabetes vs. women without prediabetes, despite a reported greater awareness of their disease risk, according to an analysis of survey data published in The Diabetes Educator.

Nicola L. Hawley

“An important consideration in determining whether prediabetes is a helpful label is the effect that it has on those receiving the diagnosis,” Nicola L. Hawley, PhD, assistant professor of epidemiology at the Yale School of Public Health, and colleagues wrote in the study background. “However, few studies have examined the effect of prediabetes diagnosis on health-related attitudes and preventive behaviors. Even fewer studies have investigated this topic in low-income minority populations, which are disproportionately affected by the growing diabetes epidemic.”

Hawley and colleagues analyzed data from 214 women aged 18 to 49 years without diabetes recruited from the Fair Haven Community Health Center in New Haven, Connecticut, in June and July 2017 (mean age, 33 years; 77.8% Hispanic; mean BMI, 32.03 kg/m²). Women completed a 77-item questionnaire based on the validated Risk Perception Survey for Developing Diabetes instrument, with general attitude items measured in a Likert-type format from 1 to 4, ranging from “strongly disagree” to “strongly agree.” Two additional items assessed risk perception for developing diabetes over the next 10 years, with and without lifestyle change; an additional two questions asked participants if they made any recent lifestyle changes to prevent diabetes onset and if they were planning on making changes in the future. Prediabetes status was self-reported.

Within the cohort, 49 women had prediabetes (self-reported prevalence, 22.9%), 63.7% reported having lived outside the United States and 49.5% reported low or very low food security. Among women with prediabetes, 49% had more than two children.

Researchers found that women with diagnosed prediabetes were more likely to worry about developing type 2 diabetes vs. women without prediabetes (80.4% vs. 62%; P < .05). Women with prediabetes were also more likely to perceive a moderate or high chance of developing type 2 diabetes in the next 10 years if they made no lifestyle changes (P < .001). However, there were no between-group differences for items measuring personal control over health and optimistic bias about health among women with vs. without prediabetes. Additionally, women with prediabetes were no more likely than women without prediabetes to report engaging in recent lifestyle change or planning to adopt lifestyle change in the near future (P > .05 for each).

In logistic regression analyses, prediabetes status was not associated with worry about developing type 2 diabetes after adjustment (OR = 2.04; 95% CI, 0.72-5.83). In the model, women with overweight were more likely to worry about developing type 2 diabetes (OR = 2.78; 95% CI, 1-7.68) as were women with a family history of prediabetes (OR = 2.29; 95% CI, 1.02-5.15).

Prediabetes diagnosis was also no longer associated with elevated general risk perception for developing diabetes in the adjusted model (OR = 1.63; 95% CI, 0.67-3.98), according to researchers. However, women with prediabetes remained more likely to consider themselves at risk for developing type 2 diabetes without making lifestyle changes in the adjusted model (OR = 6.37; 95% CI, 1.93-21.04).

“Given that preventive behaviors can substantially reduce the risk of progression from prediabetes to type 2 diabetes, it is worrisome that women diagnosed with prediabetes are not more likely to engage in these behaviors than those without this diagnosis,” the researchers wrote. “These findings signal a disconnect between an understanding of the need to make behavior change to reduce risk of diabetes and an actual engagement in those changes among women diagnosed with prediabetes.”

The researchers noted that it is “critical” that providers take account of the unique barriers to diabetes prevention that patients with prediabetes face, particularly in underserved settings. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

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