Prediabetes Awareness Barriers and Enablers: National Health and Nutrition Examination Survey 2011-2020

Prediabetes is prevalent and commonly progresses to diabetes when unaddressed. Prediabetes progression is preventable, yet prediabetes unawareness jeopardizes timely intervention. This study examines barriers and enablers of prediabetes awareness, and describes its influence on diet and physical activity.

We used the United States National Health and Nutrition Examination Survey 2011-2020 data to identify participants with prediabetes. Weighted logistic regression identified factors associated with prediabetes awareness. Weighted logistic and linear regression tested the effects of prediabetes awareness on lifestyle choices such as sugar, carbohydrate and calorie consumption, and physical activity.

Of the 2,749 adult participants identified as having prediabetes, 84% were unaware of their condition. Having had a glucose testing in the previous three years before participating in the survey was the strongest independent contributor of prediabetes awareness (AOR: 3.97, 95% CI: 2.76-5.71, P<0.0001). Prediabetes awareness was associated with weight loss intent (AOR: 1.63, 95% CI: 1.13-2.33, p<0.01), but not with healthy lifestyle choices. Healthcare professionals' advice was associated with increased exercise (AOR: 1.75, 95% CI: 1.31-2.33, p<0.01), however, not with a change in diet.

Most participants were unaware of their prediabetes condition, regardless of social determinants of health and demographic factors. This suggests the need to promote prediabetes awareness across populations. Proactively evaluating and discussing results may help narrow the unawareness chasm. Lifestyle choices not being associated with prediabetes awareness suggests that mere awareness and medical advice are not enough for patients to embrace healthy behaviors.