The impact of access to health services on prediabetes awareness: A population-based study

Assessment of prediabetes knowledge among adults in Al-Madinah, Saudi Arabia

Background: Prediabetes is a serious health condition which can be treated with changes to lifestyle behaviour. It is a significant warning sign of being at high risk of developing type 2 diabetes. This study aims to assess knowledge of prediabetes and its associated risk factors in the community of Al-Madinah, Saudi Arabia (SA). Methods: A cross-sectional study was conducted among adult respondents in Al-Madinah in 2022. A sample size of 397 participants completed a validated self-administrated survey and data were analysed using descriptive statistics (numbers, percentages, mean and standard deviation). Results: Of the 397 participants who responded to the survey, 56.7% were aged between 21 and 25 years old, with more than half (51.9%) being male and the majority being more educated (72%). Among the participants, 14.1%, 34.3% and 51.5% had a high, moderate and poor knowledge of prediabetes, respectively. Overall, there was a statistically significant association between age (>25 years old) (p = 0.003), gender difference (p = 0.006), and prediabetes knowledge. Conclusion: Knowledge of prediabetes is important in the prevention of type 2 diabetes. The population of Al-Madinah demonstrated a low level of prediabetes knowledge; therefore, the design and implementation of community-based intervention programmes with an emphasis on raising prediabetes awareness is crucial. Policymakers, organisations and partnerships will be required to develop a well-designed and effective programme.

A community-based prediabetes knowledge assessment among Saudi adults in Al-Ahsa region, 2018

Background: Prediabetes has been considered to be a reversible condition; a modification of lifestyle and other intervention can be successfully applied during the prediabetes period to prevent the development of type 2 diabetes. The purpose of the present study was to assess knowledge of prediabetes and its risk factors for the community in the Al-Ahsa region. Design and method: A cross-sectional community-based study was conducted in the Al-Ahsa region from mid-to-late December 2018. A sample size of 812 was determined using a single-proportion formula. Results: Of the 812 respondents who gave consent to participate in the interview; the male to female ratio was 1.1:1. 13.2% of the respondents reported that they had diabetes. Among the respondents, 87.1% had a high level of knowledge of prediabetes, while 12.9% had low-to-moderate knowledge. 84% of males 40 years of age or older, 88.7% (384) of people with university or higher education, and 95.1% (78) of people who worked as health practitioners had high knowledge of prediabetes. Overall, there was a statistically significant association between age and prediabetes knowledge (χ2 =5.006, p=0.025). Occupation also showed a significant statistical association with prediabetes knowledge (χ2 =9.85, p=0.02). Conclusion: Knowledge is considered an important factor in the prevention of prediabetes and diabetes. People in Al-Ahsa demonstrated a high level of knowledge regarding some risk factors for prediabetes. However, there were a number of deficiencies in the knowledge of prediabetes risk factors and preventive measures as well as in general knowledge of prediabetes, which may lead to a high prevalence of prediabetes and diabetes.

Health Insurance Is Associated with Decreased Odds for Undiagnosed Prediabetes and Type 2 Diabetes in American Adults

Over a third of adults in the United States have prediabetes, and many of those with prediabetes will progress to type 2 diabetes within 3-5 years. Health insurance status may factor into a proper diagnosis of prediabetes and diabetes. This study sought to determine the associations between health insurance and undiagnosed prediabetes and diabetes in a national sample of American adults. Publicly available data from 13,029 adults aged 18-64 years from the 2005-2016 waves of the National Health and Nutrition Examination Survey were analyzed. Health insurance type (Medicaid, Private, Other, None) was self-reported. Prediabetes and diabetes status were assessed with measures of self-report, glycohemoglobin, fasting plasma glucose, and two-hour glucose. Covariate-adjusted logistic models were used for the analyses. Overall, 5976 (45.8%) participants had undiagnosed prediabetes, while 897 (6.8%) had undiagnosed diabetes. Having health insurance was associated with decreased odds ratios for undiagnosed prediabetes: 0.87 (95% confidence interval (CI: 0.79, 0.95)) for private insurance, 0.84 (CI: 0.73, 0.95) for other insurance, and 0.78 (CI: 0.67, 0.90) for Medicaid. Moreover, having private health insurance was associated with 0.82 (CI: 0.67, 0.99) decreased odds for undiagnosed diabetes. Health insurance coverage and screening opportunities for uninsured individuals may reduce prediabetes and diabetes misclassifications.

Falling into a deep dark hole: Tongan people's perceptions of being at risk of developing type 2 diabetes

Background

Prediabetes is a precursor for type 2 diabetes. Compared to the New Zealand/European and other population groups (24.6%), the prevalence of prediabetes is higher within Pacific groups (29.8%). The diagnosis of prediabetes presents a potential opportunity to intervene to prevent progression to type 2 diabetes.

Objective

To develop an understanding of how being ‘at risk’ of developing type 2 diabetes is perceived by Tongan people with prediabetes living in Auckland, New Zealand.

Methods

The Kakala and Talanga Tongan methodologies underpinned this study. Twelve one‐on‐one, semi‐structured interviews with Tongan patients who had prediabetes from a primary health‐care clinic in Auckland, New Zealand, were conducted. Thematic analysis was used to identify recurrent themes from the data.

Results

Participants were not aware of their prediabetes diagnosis, emotions associated with the diagnosis reflected fear and disbelief and a perception of imminent danger. Family history informed perceptions of the risk of developing type 2 diabetes. Participants could not differentiate prediabetes from type 2 diabetes, and recollections of being ‘back in the Islands’ of Tonga were consistent with healthy lifestyles.

Conclusions

Prediabetes appeared to be poorly understood and was believed to be irreversible, which could discourage behaviour change, social and physical improvements in health. Appropriate culturally tailored messages to accompany a prediabetes diagnosis, including cause and management, would be beneficial for Pacific peoples.

Perception of Risk of Developing Diabetes Among Patients With Undiagnosed Prediabetes: The Impact of Health Care Provider Advice

IN BRIEF Patient awareness of prediabetes and an increased diabetes risk is crucial to diabetes prevention. This article reports on a study investigating perceptions of diabetes risk among U.S. adults with prediabetes and the role of physician communication about risks in influencing patient perceptions. This study demonstrates that few patients with undiagnosed prediabetes are even told that they are at high risk for diabetes. This study provides further evidence that diabetes prevention requires improved patient-centered care, which likely begins with the delivery of adequate information to patients.

Implementing an Online Weight-Management Intervention to an Employee Population: Initial Experience with Real Appeal

OBJECTIVE

Given the disease burden and economic costs of obesity in the United States, scalable approaches to weight loss and weight management are needed. This study evaluated self-reported weight-loss outcomes associated with a commercial intensive lifestyle intervention marketed to employers and delivered electronically to employees.

METHODS

Data were collected for participants who enrolled in an online intensive lifestyle intervention weight-loss program from July 2015 through June 2016. An intent-to-treat analysis of participants who attended at least one session is reported.

RESULTS

Ninety-six companies, with approximately 437,215 eligible adult beneficiaries, launched Real Appeal in July 2015. In the first 12 months of the program, 69,598 adults enrolled and 87% met at-risk criteria for prediabetes, diabetes, or cardiovascular disease. The intent-to-treat cohort (n = 52,461), all of whom attended at least one session, lost an average of 2.8% body weight, with 23% achieving 5% or more weight loss. Active participants (n = 38,836) lost an average of 3.5% body weight, with 29% achieving 5% weight loss. Program completers (n = 27,164) lost an average of 4.3% body weight, with 36% of the cohort achieving 5% weight loss.

CONCLUSIONS

This study demonstrated that an employer-offered, online, behavioral weight-loss program was an effective, scalable solution for engaging more than 50,000 participants with overweight and obesity.

Associations Between Depressive Symptoms and Indices of Obesity in Adults With Prediabetes and Normal Blood Glucose Levels: Results From the Emotional Health and Wellbeing Study

OBJECTIVES

This study describes associations between depressive symptoms and indices of obesity in a community sample of adults with prediabetes. The strengths of these associations were compared to those observed in individuals with normal blood glucose levels.

METHODS

Cross-sectional data came from the baseline assessment of the Emotional Health and Wellbeing Study. Participants were classified as meeting the American Diabetes Association criteria for prediabetes (n=1,152) or normal blood glucose levels (n=1,567). Indices of obesity included body mass index, waist circumference and fat mass index.

RESULTS

After adjusting for sociodemographic covariates, greater depressive symptoms were associated with greater body mass index, waist circumference and fat mass index. These associations were stronger in participants with prediabetes compared to participants with normal blood glucose levels. The pattern of results observed for body mass index and waist circumference held after controlling for self-reported fruit and vegetable consumption, physical activity and sedentary time, but the strength of the interaction was attenuated for fat mass index.

CONCLUSIONS

Depressive symptoms were more strongly associated with indices of obesity in people with prediabetes than in people with normal blood glucose levels. Depressive symptoms may be a barrier to weight management in people with prediabetes.

Comparison of access to health services among urban-to-urban and rural-to-urban older migrants, and urban and rural older permanent residents in Zhejiang Province, China: a cross-sectional survey

BACKGROUND

While much literature reported the access of Chinese older migrants to health services, little was known about the differences among sub-groups of older adults, including urban-to-urban and rural-to-urban migrants, and urban and rural permanent residents. This study aimed to examine the access of these four groups to health services in Zhejiang Province, China and provide an evidence for the development of health services policies.

METHODS

A cross-sectional survey was conducted in community-dwelling older adults (aged 60 years or above) in 2013. Participants were recruited by random sampling. Demographic information and access to health services for the elderly populations were obtained via interviews using a self-designed structured questionnaire. Pearson's chi-square tests and Cochran-Mantel-Haenszel (CMH) tests were performed to examine the differences in access to health services among the four groups. Binary logistic regression was conducted to explore the associations of participants' visits to doctors with their group status after controlling confounding factors.

RESULTS

The two-week hospital visiting rates were significantly lower in migrants (55.56% in rural-to-urban and 62.50% in urban-to-urban) than that in urban and rural permanent residents (67.40 and 82.25%, respectively; p < 0.01). The majority of older adults who received a diagnosis indicating need for hospital treatment accepted the treatment, with no significant difference among the four groups after controlling for health service need (χ2 = 7.08, p = 0.07). On the other hand, 30.05% of the older adults did not visit a doctor when they got ailments in the past 2 weeks prior to the survey, and 16.42% (33/201) did not receive hospital treatment after receiving a diagnosis indicating need for hospital treatment. Factors including age, marital status, educational attainment, major financial source, and living with family members did not influence health services use.

CONCLUSIONS

Targeted social and health policies integrating the strengths of government, society and families should be implemented to further improve health services use for different groups of older adults.

Prevalence of Obesity, Prediabetes, and Diabetes in Sexual Minority Women of Diverse Races/Ethnicities: Findings From the 2014-2015 BRFSS Surveys

Purpose

The purpose of this study is to assess the weighted prevalence and odds ratios of obesity, prediabetes, and diabetes by (1) female sexual orientation (lesbian, bisexual, and straight) with racial/ethnic (Hispanic, non-Hispanic black, and non-Hispanic white) groups combined and (2) across and within racial/ethnic groups by sexual orientation.

Methods

A secondary analysis of pooled 2014-2015 Behavioral Risk Factor Surveillance System data from 28 states (N = 136 878) was conducted. Rao-Scott chi-square test statistics were computed and logistic regression models were developed to assess weighted prevalence and odds ratios of obesity, prediabetes, and diabetes with adjustments for demographics (age, income, and education), depression, and health care access factors.

Results

With racial/ethnic groups combined, lesbian and bisexual women, relative to straight women, had a significantly increased likelihood for obesity when controlling for demographics. Bisexual women were found to have significantly reduced odds for diabetes, compared with straight women, with adjustments for demographics, depression, and health care access factors. Compared with their non-Hispanic white counterparts, Hispanic lesbian women had significantly increased odds for obesity and diabetes, while non-Hispanic black bisexual women had a significantly greater likelihood for obesity, holding demographics, depression, and health care access factors constant. Non-Hispanic white lesbian women had an increased likelihood for obesity relative to their straight, ethnic/racial counterparts. Prediabetes subsample analysis revealed the prevalence was low across all female sexual orientation groups.

Conclusion

Sexual minority women, particularly those of color, may be at increased risk for obesity and diabetes. Research is needed to confirm the findings.

When Should "Pre" Carry as Much Weight in the Diabetes Comorbidity Debate? Insights From a Population-Based Survey

INTRODUCTION

Estimates indicate that 86 million people in the United States fit the clinical definition of prediabetes, which contributes to the epidemic of nearly 2 million new diagnoses of type 2 diabetes mellitus each year. Effort has focused on preventing prediabetes from progressing to clinical diabetes. We investigated the sociodemographic, behavioral, and health factors in people diagnosed with diabetes or prediabetes and associated leading indicators and comorbidities.

METHODS

We used Behavioral Risk Factor Surveillance System data from 2011 through 2015 (N = 1,699,754). All respondents aged 18 years or older with complete covariate data were included, differentiating between self-reported diagnosis of diabetes or prediabetes. Weighted univariate and multivariable logistic regression analyses of 28 variables were developed, with adjusted odds of diagnosis, and standardized coefficients were calculated to rank predictors for diabetes and prediabetes.

RESULTS

Prevalence of prediabetes increased each year between 2011 and 2014. After adjusting for demographic, lifestyle, and health variables, the most significant predictors in magnitude of importance for prediabetes and diabetes were age and body mass index. Although adjusted odds for cardiovascular disease and kidney disease were higher in respondents with diabetes than in those with prediabetes, respondents with prediabetes had higher adjusted odds of arthritis, depressive disorder, cancer, and chronic obstructive pulmonary disease.

CONCLUSIONS

Concurrent chronic diseases occur in people with prediabetes even at normal and overweight classifications. By identifying the conditions that are concomitant with diabetes, people with prediabetes can be provided with more rigorous and individualized treatments that can lead to better population health.