Among US adults with prediabetes, only half engage in recommended prevention behaviors and little has been done to examine the role of multiple social risk factors. Data from 4,310 adults with prediabetes (weighted 34,442,989) in the National Health Interview Survey 2016–2017 was used. Predictor variables included six social risk factors. Outcome variables included (1) receiving counseling for lifestyle change and (2) engaging in lifestyle change behaviors. Multiple logistic regression (glm function with poisson family and log link) models were run to estimate prevalence ratios, adjusting for relevant covariates. In the fully adjusted models, inadequate access to care was associated with lower prevalence of receiving all forms of counseling for physical activity (PR = 0.63; CI 0.51; 0.78), fat/calories (PR = 0.70; CI 0.56; 0.86) and weight loss program (PR = 0.33; CI 0.19; 0.59). Lack of community was associated with lower prevalence of increasing physical activity (PR = 0.94; CI 0.88; 1.00). Educational deficit was associated with lower prevalence of increasing physical activity (PR = 0.88; CI 0.82; 0.94), reducing fat/calories (PR = 0.89; CI 0.83; 0.95) and being in a weight loss program (PR = 0.66; CI 0.51; 0.87). Food insecurity was associated with lower prevalence of reducing fat/calories (PR = 0.91; CI 0.84; 0.98). Inadequate access to care was associated with lower prevalence of being in a weight loss program (PR = 0.43; CI 0.23; 0.81). This study underscores the role of social risk factors in limiting diabetes prevention at a national level. To effectively address the barriers to diabetes prevention adoption in the US, social risk factors need to be accounted for as a part of a holistic care plan.
Egede et al. (Tue,) studied this question.