Definition

Percentage of adults who have ever been told by a doctor or other health professional that they have prediabetes or borderline diabetes. Prediabetes is a condition in which an individual's blood sugar level is elevated but not high enough to reach a clinical diagnosis for diabetes.

Numerator

Number of adults who have been told by a doctor they have prediabetes.

Denominator

All Utah adults.

Data Interpretation Issues

Data for this indicator come from the Utah Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey that asks respondents to report if they had ever been told by a health care professional if they had prediabetes. The term "prediabetes" is often called impaired fasting glucose or insulin resistance. It is also sometimes referred to as "borderline diabetes." An individual may actually have "prediabetes" but respond with "No," as the health care provider may not have actually said he/she had "prediabetes" or "borderline diabetes."

Why Is This Important?

The American Diabetes Association defines "prediabetes" as a fasting plasma glucose level between 100 mg/dL and 125 mg/dL. A1C tests are commonly used for diagnosing prediabetes. A1C levels greater than or equal to 5.7% and less than 6.5% are used to indicate prediabetes. Another test used is the Oral Glucose Tolerance Test. Values between 140 mg/dL and 199 mg/dL indicate prediabetes. Although blood sugar levels for prediabetes do not meet the clinical threshold for a diagnosis of diabetes, individuals with prediabetes still have an increased risk for heart disease, stroke, and type 2 diabetes. However, many people with prediabetes are unaware of their condition. Once individuals are aware that they have prediabetes and of their increased risk of developing diabetes and cardiovascular complications, they can make the necessary lifestyle changes to prevent or at least delay progression to type 2 diabetes. Simple lifestyle changes, such as losing weight, eating more fruits and vegetables, and increasing physical activity, can reduce the risk of developing type 2 diabetes. Without making lifestyle changes, approximately half of individuals diagnosed with prediabetes progress to diabetes within ten years. More information about the clinical thresholds for prediabetes can be found at [http://www.diabetes.org/diabetes-basics/diagnosis].

Healthy People Objective D-16:

Increase prevention behaviors in persons at high risk for diabetes with pre-diabetes
U.S. Target: Not applicable, see subobjectives in this category

Other Objectives

Healthy People 2030 objectives: reduce the number of diabetes cases diagnosed yearly (D-01), reduce proportion of adults who don't know they have prediabetes (D-02), and increase the proportion of eligible people completing CDC-recognized type 2 diabetes prevention programs (D-D01).

How Are We Doing?

The Centers for Disease Control and Prevention (CDC) estimates that about one-third of U.S. adults (aged 20 and over) have prediabetes. Most people with prediabetes do not know they have it. The Utah Department of Health (UDOH) has been working to increase awareness of prediabetes. In 2013, 5.8% of adults reported they had been told by a health care provider that they had prediabetes (crude rates). Data collected in 2018 (Behavioral Risk Factor Surveillance System) showed this percentage increased to 9.5% (crude rates). While this increased rate may be partly due to a true increase, it likely reflects the increased awareness by providers and patients.

How Do We Compare With the U.S.?

Adults in the U.S. generally have a higher rate of being diagnosed with prediabetes than adults in Utah. National data from 2018 Behavioral Risk Factor Surveillance System (BRFSS) indicated that 11.0% (age-adjusted) of adults in the U.S. had been told by a doctor or other health professional that they have prediabetes. In Utah, about 10.4% (age-adjusted) of adults have been told by a provider that they have prediabetes (BRFSS 2018). The actual percentages in Utah and in the U.S. are probably much higher. About 86 million Americans (roughly 35% of adults aged 20 years and older) may actually have prediabetes.

What Is Being Done?

In 2013, the Utah Department of Health (UDOH) received funding to increase awareness of prediabetes. While it may seem counterintuitive, the UDOH is working towards increasing the rate of prevalence of prediabetes in the Behavioral Risk Factor Surveillance System. National data suggest that many individuals have prediabetes but have not been told so by a health care provider and are not aware they have it. The UDOH is working to increase awareness of this condition among health care providers as well as individuals at risk.

Evidence-based Practices

The Centers for Disease Control and Prevention (CDC) promotes the Diabetes Prevention Recognition Program (DPRP) as part of its efforts to prevent diabetes. The DPRP provides recognition to qualified organizations that can effectively deliver a lifestyle change intervention program. In most states, participants pay to attend the program. The program consists of 16 sessions taught by a trained lifestyle coach. The program includes at least six additional follow-up sessions. DPRP-recognized programs submit reports to DPRP every six months with data on participants' progress. More information is available at [http://www.cdc.gov/diabetes/prevention/recognition/index.htm].

Available Services

The American Diabetes Association (ADA) is an excellent resource for all types of information on diabetes. Call 1-800-DIABETES or visit the [http://www.diabetes.org website]. The [https://www.niddk.nih.gov/health-information/communication-programs/ndep National Diabetes Education Program] has resources for diabetes management for professionals, businesses, and patients. Most materials are available upon request at no charge. The [https://www.cdc.gov/diabetes/prevention/index.html National Diabetes Prevention Program] has resources for diabetes prevention for employers, insurers, health care professionals, program providers, and individuals. The [https://health.utah.gov/ Utah Department of Health] has a Health Resource hotline: 1-888-222-2542. Please call this number for information about self-management programs in Utah. The [http://www.choosehealth.utah.gov/your-health/lifestyle-change/dsme.php Healthy Living through Environment, Policy and Improved Clinical Care (EPICC) website] provides information on diabetes self-management classes. [http://www.diabeteseducator.org Association of Diabetes Educators][[br]] 800-338-3633[[br]] Local Chapter Facebook Page: [https://www.facebook.com/aadeutah] [http://www.heart.org American Heart Association][[br]] 1937 S. 300 W. #120[[br]] Salt Lake City, UT 84115[[br]] (801) 484-3838 or[[br]] 1-800-242-8721[[br]] You can find and enroll in National Diabetes Prevention Program, an evidence-based health program for prediabetes at [https://livingwell.utah.gov/program.php?topic=ndpp].

Health Program Information

Increasing awareness of prediabetes is a primary goal for the Healthy Living Through Environment, Policy and Improved Clinical Care [http://choosehealth.utah.gov/ (EPICC)] Program. The EPICC Program supports environmental and policy changes that will assist individuals in their efforts to increase physical activity and increase consumption of healthful fruits and vegetables and nutritious beverages. The ultimate goal of the EPICC Program is to provide a sustainable environment that promotes healthful behaviors.

Relevant Population Characteristics

Being overweight, physically inactive, aged 45 or over, or having a close family member with diabetes increases the risk for prediabetes. Women who have had gestational diabetes or have given birth to a baby weighing more than nine pounds at birth are also at risk. The Centers for Disease Control and Prevention developed a [https://www.cdc.gov/diabetes/prevention/pdf/Prediabetes-Risk-Test-Final.pdf prediabetes screening test].

Health Care System Factors

Prediabetes is estimated to increase the cost of medical care in the U.S. by about $25 billion. Diabetes related costs account for higher out-of-pocket medical costs and higher insurance premiums. See [https://www.ncbi.nlm.nih.gov/pubmed/23468086 Economic Costs of Diabetes in the U.S. in 2012].

Risk Factors

Some people diagnosed with prediabetes will develop diabetes. Being overweight or obese is a major risk factor for developing diabetes. The risk of developing diabetes can be substantially reduced through weight loss and regular physical activity. The National Diabetes Primary Prevention Study (National DPP) showed that weight loss and participation in regular physical activity can significantly decrease the risk. The National DPP clinical trial included over 3,000 people who had impaired fasting glucose and were at an increased risk for developing diabetes. Participants who engaged in moderately intense physical activity for 30 minutes per day and lost 5 to 7 percent of their body weight decreased their risk of diabetes dramatically. This change was effective for all participants in the study, regardless of age or ethnic group (see [http://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Pages/default.aspx]). Some risk factors cannot be modified, such as older age or membership in a minority racial or ethnic group. Nevertheless, risk can be substantially reduced through adhering to a nutritious diet and participating in regular physical activity.

Health Status Outcomes

Prediabetes greatly increases the risk of developing diabetes. Diabetes can have serious consequences. It is the leading cause of non-traumatic lower extremity amputations, and is also the leading cause of blindness among working-age adults. It is a major risk factor for cardiovascular disease and end-stage renal disease. Diabetes can affect both physical and mental health. Complications from diabetes can have a significant impact on quality of life. Blindness and amputations affect one's independence and ability to conduct everyday activities.

In 2018, the Utah adult prediabetes rate (10.4%) was lower than the U.S. rate (11.0%).

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Prediabetes questions were not asked in Utah in 2015 or 2019.[[br]] Age-adjusted to U.S. 2000 standard population. [[br]] U.S. data does not include U.S. territories, but does include Dist. of Columbia. [[br]] Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. Comparisons between 2011 and prior years should be made with caution. More details about these changes can be found at [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf].

Higher rates in the graph may indicate higher prevalence of prediabetes; however, higher rates may also mean that some local health districts have higher detection rates of prediabetes.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]][[br]]Age-adjusted to U.S. 2000 standard population. Prediabetes questions were not asked in Utah in 2015 or 2019. Prior to 2015 San Juan County was part of the Southeast Local Health District. In 2015 the San Juan County Local Health District was formed. Data reported are for all years using the current boundaries.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

The rate of prediabetes diagnosis increases after age 50 for both men and women.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Hispanic adults had significantly higher rates of diagnosed prediabetes than non-Hispanic adults.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Age-adjusted to U.S. 2000 standard population. Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Prediabetes rates for male and female were comparable to the state rate.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Age-adjusted to U.S. 2000 standard population. Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Generally, prediabetes rates decreased with higher education levels.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Age-adjusted to U.S. 2000 standard population. Note the higher age-adjusted rate for the state, as this view is for adults aged 25 and over (not 18 and over). Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Adults who were obese had almost double the state rate for prediabetes.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Age-adjusted to U.S. 2000 standard population. Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

The rate of prediabetes was three times higher in adults who had ever been told they had high cholesterol than adults who had never been told. The cholesterol question was not asked on the 2018 BRFSS, therefore 2017 is the most up-to-date data we have on age-adjusted rates of prediabetes by cholesterol level.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Age-adjusted to 2000 U.S. standard population. Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Adults with hypertension had a higher rate of prediabetes diagnosis than adults without hypertension. The hypertension question was not asked on the 2018 BRFSS, therefore 2017 is the most up-to-date data we have on age-adjusted rates of prediabetes by cholesterol level.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]]Age-adjusted to 2000 U.S. standard population. Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase precision of the estimates. With this change Utah data is more consistent with both the U.S. and other states using IBIS. Data used in graphs from 2011 forward have been updated to reflect this change.   [[br]][[br]]*Use caution in interpreting; the estimate has a coefficient of variation > 30% and is therefore deemed unreliable by Utah Department of Health standards. **The estimate has been suppressed because either the relative standard error is greater than 50% or can't be determined. Age-adjusted to U.S. 2000 standard population. Prediabetes questions were not asked in Utah in 2015 or 2019.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

References and Community Resources

American Diabetes Association[[br]] [http://www.diabetes.org][[br]] [[br]] Diabetes Prevention Program[[br]] National Diabetes Information Clearinghouse[[br]] [http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram][[br]] [[br]] Division of Diabetes Translation, Centers for Disease Control and Prevention[[br]] [http://www.cdc.gov/diabetes][[br]] [[br]] American Association of Diabetes Educators [[br]] [http://www.diabeteseducator.org][[br]] Local Chapter Facebook Page: [https://www.facebook.com/aadeutah] Information on registering for self-management prediabetes and diabetes programs can be found at [http://livingwell.utah.gov/index.php].