Reach and Use of Diabetes Prevention Services in the United States, 2016-2017
Reach and Use of Diabetes Prevention Services in the United States, 2016-2017
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DOI：
10.1001/jamanetworkopen.2019.3160
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Gregg, Edward W.
中科院分区：
文献类型：
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作者：
Ali, Mohammed K.;Bullard, Kai McKeever;Gregg, Edward W.
重要性：美国国家组织正在协调努力，实施以证据为基础的生活方式改变项目，以降低2型糖尿病（以下简称糖尿病）和心血管风险。目的了解全国糖尿病预防服务的可及性和使用情况。从2017年8月3日至2018年11月15日，对2016年和2017年全国健康访谈调查数据进行了具有全国代表性的、基于人群的横断面分析。非怀孕、非住院、18岁或以上的糖尿病高风险平民受访者，定义为没有自我报告的糖尿病诊断，但诊断为糖尿病前期或美国糖尿病协会（ADA）风险评分升高（bbb50）的人。对体重指数升高的成年人进行了分析（在敏感性分析中，对那些没有体重指数升高的成年人进行了分析）。评估了在过去一年中接受饮食建议、身体活动指导、转介减肥计划、转介糖尿病预防计划或其中任何一项建议以及确认参与每项（或任何）活动的高危成年人的绝对数量和比例。为了确定存在差距的地方，绘制了一个预防连续图，标出了现有的和期望的目标实现情况。降低风险的活动因年龄、性别、种族/民族、教育程度、保险状况、妊娠糖尿病史、高血压或体重指数而异。结果：该分析包括50912名18岁及以上（平均年龄46.1[0.2]岁，48.1%[0.3%]男性）的受访者（代表全国2.23亿成年人），他们的数据完整，没有医疗保健专业人员自我报告的糖尿病诊断。在代表的人群中，36.0%（8000万）的人要么被医生诊断为前驱糖尿病（1790万），要么ADA风险评分升高（7330万），要么两者兼而有之（1130万）。在诊断为前驱糖尿病的患者中，73.5%（95% CI, 71.6%-75.3%）报告接受了医疗保健专业人员关于降低糖尿病风险的建议和/或转诊，其中35.0% （95% CI, 30.5%-39.8%）至75.8% （95% CI, 73.2%-78.3%）报告在过去一年中参与了相应的活动或项目。ADA风险评分升高但未诊断为前驱糖尿病的成年人中有一半（50.6%;95% CI, 49.5%-51.8%）报告接受了降低风险的建议和/或转诊，其中33.5%（95% CI, 30.1%-37.0%）至75.2%（95% CI, 73.4%-76.9%）报告参加了活动和/或项目。糖尿病预防项目的参与率极低。健康保健专业人士建议，年龄在45 - 64岁之间，受教育程度较高，健康保险状况，妊娠期糖尿病，高血压和肥胖与参与风险降低活动和/或项目的程度较高相关。结论和相关性在糖尿病高危成人中，在接受建议和/或转诊以及参与糖尿病风险降低活动和/或项目方面存在重大差距。这些结果表明，风险感知、卫生保健专业人员转诊和沟通以及保险范围可能是增加美国成年人降低风险行为的关键杠杆。这些发现为监测未来项目的可用性和覆盖范围、糖尿病前期的识别以及项目的转诊和保留提供了基准。
IMPORTANCE Coordinated efforts by national organizations in the United States to implement evidence-based lifestyle modification programs are under way to reduce type 2 diabetes (hereinafter referred to as diabetes) and cardiovascular risks.OBJECTIVE To provide a status report on the reach and use of diabetes prevention services nationally.DESIGN, SETTING, AND PARTICIPANTS This nationally representative, population-based cross-sectional analysis of 2016 and 2017 National Health Interview Survey data was conducted from August 3, 2017, through November 15, 2018. Nonpregnant, noninstitutionalized, civilian respondents 18 years or older at high risk for diabetes, defined as those with no self-reported diabetes diagnosis but with diagnosed prediabetes or an elevated American Diabetes Association (ADA) risk score (>5), were included in the analysis. Analyses were conducted for adults with (and in sensitivity analyses, for those without) elevated body mass index.MAIN OUTCOMES AND MEASURES Absolute numbers and proportions of adults at high risk with elevated body mass index receiving advice about diet, physical activity guidance, referral to weight loss programs, referral to diabetes prevention programs, or any of these, and those affirming engagement in each (or any) activity in the past year were estimated. To identify where gaps exist, a prevention continuum diagram plotted existing vs desired goal achievement. Variation in risk-reducing activities by age, sex, race/ethnicity, educational attainment, insurance status, history of gestational diabetes mellitus, hypertension, or body mass index was also examined.RESULTS This analysis included 50 912 respondents (representing 223.0 million adults nationally) 18 years or older (mean [SE] age, 46.1 [0.2] years; 48.1%[0.3%] male) with complete data and no self-reported diabetes diagnosis by their health care professional. Of the represented population, 36.0%(80.0 million) had either a physician diagnosis of prediabetes (17.9 million), an elevated ADA risk score (73.3 million), or both (11.3 million). Among those with diagnosed prediabetes, 73.5%(95% CI, 71.6%-75.3%) reported receiving advice and/or referrals for diabetes risk reduction from their health care professional, and, of those, 35.0% (95% CI, 30.5%-39.8%) to 75.8% (95% CI, 73.2%-78.3%) reported engaging in the respective activity or program in the past year. Half of adults with elevated ADA risk scores but no diagnosed prediabetes (50.6%; 95% CI, 49.5%-51.8%) reported receiving risk-reduction advice and/or referral, of whom 33.5%(95% CI, 30.1%-37.0%) to 75.2%(95% CI, 73.4%-76.9%) reported engaging in activities and/or programs. Participation in diabetes prevention programs was exceedingly low. Advice from a health care professional, age range from 45 to 64 years, higher educational attainment, health insurance status, gestational diabetes mellitus, hypertension, and obesity were associated with higher engagement in risk-reducing activities and/or programs.CONCLUSIONS AND RELEVANCE Among adults at high risk for diabetes, major gaps in receiving advice and/or referrals and engaging in diabetes risk-reduction activities and/or programs were noted. These results suggest that risk perception, health care professional referral and communication, and insurance coverage may be key levers to increase risk-reducing behaviors in US adults. These findings provide a benchmark from which to monitor future program availability and coverage, identification of prediabetes, and referral to and retention in programs.