Knowledge of diabetes is high, but this knowledge is not being translated into action

June 29, 2011

A large survey of American households reveals generally high knowledge of diabetes and its risk factors, yet few people willing to change behavior to improve their health. Further, predictors for progression to type 2 diabetes are easy to identify from respondents? reports.

A large survey of American households reveals generally high knowledge of diabetes and its risk factors, yet few people willing to change behavior to improve their health. Further, predictors for progression to type 2 diabetes are easy to identify from respondents’ reports.
     The Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD) is a U.S.-population-based 5-year observational study of:

Adults with type 1 diabetes (n = 366);

Adults with type 2 diabetes (n = 3897);

Persons at high risk for developing diabetes (n = 5449), defined as 3 or more of the following factors: abdominal obesity, body mass index 28 kg/m2 or higher, dyslipidemia, hypertension, cardiovascular disease; and

Persons at low risk (n = 5725), defined as having 2 or fewer of the above-listed factors.

     Of the 200,000 households that received the screening questionnaire in 2004, 127,420 households (containing a total of 211,097 adults) returned completed questionnaires. The follow-up baseline survey was mailed to 22,001 respondents to be followed over the subsequent 5 years with annual surveys.  
     Some 87% of the 3867 respondents with type 2 diabetes in the baseline survey said they knew that obesity can aggravate or contribute to the onset of chronic disease, reported Andrew Green, MD.
     Yet while 70% of respondents with type 2 diabetes said they had tried to lose weight over the previous 12 months, only 34% said they had maintained the desired weight for more than 6 months.
     Nearly two thirds (63%) of the cohort with type 2 diabetes reported their health professional had recommended an increase in physical activity in the past 12 months, but 87% reported they were inactive within the past 7 days.  Seventeen percent with type 2 diabetes indicated that they would rather take medicine for their health problems than change their lifestyle, and 5% reported they didn’t even bother to try and stay healthy.
     Even those with a comorbid condition were not motivated toward healthy behavior, said Green, an endocrinologist at Midwestern Endocrinology in Overland Park, Kansas. Three fourths (74% ) of 1150 very-high-risk individuals (those with diabetes and cardiovascular disease) reported that they did not exercise regularly.
     The rate of transition to type 2 diabetes was 6.8% over 5 years, or 1.36% per year, said Helena Rodbard, MD, an endocrinologist at Endocrine and Metabolic Consultants in Rockville, Maryland. The most significant predictor for developing type 2 diabetes was increasing age, which increased risk by 4- to 6-fold and was highest for those 55 to 64 years old. High blood sugar without diabetes increased risk of developing diabetes by 5-fold. Other predictors were abdominal obesity (50% increased risk), family history of type 2 diabetes (50% increased risk), asthma (30% increased risk), and excessive thirst (40% increased risk). Those who rated themselves in good or excellent health were significantly less likely to transition to diabetes.
     James Gavin III, MD, PhD, Clinical Professor of Medicine at Emory University in Atlanta, said that practical, patient-friendly self-management tools to control weight would help patients with type 2 diabetes. Changes in public health policy, such as a greater role for and better access to diabetes educators, and other incentives, such as insurance discounts, are needed to help translate knowledge to health-positive behavior.

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