Diabetes risk perception not associated with greater risk-reducing behaviors


Intensive lifestyle change remains the primary treatment for youth-onset type 2 diabetes. According to a study in Jama Network Open, there is more work to be done as risk perception and awareness of diabetes alone were not associated with risk-reducing behaviors.

Diabetes risk perception not associated with greater risk-reducing behaviors | Image Credit: © JEGAS RA - © JEGAS RA - stock.adobe.com.

Diabetes risk perception not associated with greater risk-reducing behaviors | Image Credit: © JEGAS RA - © JEGAS RA - stock.adobe.com.

Among a US-representative sample of overweight adolescents or those with obesity, risk perception of diabetes was not linked with more participation of risk-reducing activities or behaviors, according to a study published in Jama Network Open.

Youth-onset type 2 diabetes is increasing in prevalence, which leads to microvascular complications in about 80% of patients within 20 years post diagnosis, according to study authors. The primary treatment is still intensive lifestyle changes, as “no medications have demonstrated reduction in progression from prediabetes to type 2 diabetes in youth,” the authors wrote.

The study, using pediatric data representative on a national level, included individuals aged 12 to 17 years with a body mass index (BMI) in the 85th percentile or higher “for age and sex and with available hemoglobin A1c (HbA1c) measurement in the National Health and Nutrition Examination Survey (NHANES), waves 2011 to 2012, 2013 to 2014, 2015 to 2016, and 2017 to 2018,” while analyses were conducted from February 2022 to February 2023.

Physical activity, screen time, and attempted weight loss were outcomes of the study while age, sex, race and ethnicity, and objective diabetes risk (BMI, HbA1c) were cofounders. The Diabetes Questionnaire was used to determine awareness and perception of risk. The age range of 12 to 17 years was deemed appropriate for the investigators, as this range maintained consistency in survey questions, which were altered by age. Physical activity and weight-related surveys were answered by youth individuals directly, while nutrition and diabetes surveys were answered by parent proxies for those younger than 16 years. Reported risk perception and awareness by differences in age (young vs older than 16 years) were assessed. Sensitivity analyses, determining response bias, were conducted if differences were significant.

According to the study, “Risk perception was defined using the question, ‘Do you feel you could be at risk for diabetes or prediabetes?’ while risk awareness was an affirmative to either ‘Have you ever been told by a doctor or other health professional that you have any of the following: prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline diabetes or that your blood sugar is higher than normal but not high enough to be called diabetes or sugar diabetes?’ (prediabetes) or ‘Have you ever been told by a doctor or other health professional that you have health conditions or a medical or family history that increases your risk for diabetes?’ (diabetes risk).”

Measures of household food security, health insurance, access to health care, income, and size of household (total members in household) were included to assess potential barriers to health behavior change. Diabetes risk-reducing health behaviors included, “consumption of fast food, pizza, or non–home-prepared meals, physical activity and sedentary time, and frequency of attempted weight loss.”

In all, the study consisted of 1341 participants with a mean age of 15 years (95% CI, 14.9-15.2 years) and a mean BMI z score of 1.76 (95% CI 1.73-1.79). The study participants represented a total of 8,716,794 youths that met the criteria of the study. Of youths with elevated HbA1c, approximately one-third felt at risk for diabetes, “significantly more than youths with normal HbA1c (30.1% [95% CI, 23.1%- 38.1%] vs 19.6% [95% CI, 16.4%-23.3%]; P = .006)” the authors stated. “Risk perception was also significantly higher among those aged 16 to 17 years than among those aged 12 to 15 years (aged 16 to 17 years: 26.4% [95% CI, 21.8%-31.6%]; unweighted n = 448, weighted n = 2 932 359; aged 12 to 15 years: 17.5% [95% CI, 14.1%-21.6%]; unweighted n = 893, weighted n = 5 784 435; P = .002).”

For elevated HbA1c individuals, 22.1% stated they are aware of “diabetes risk” (95% CI, 15.2%-30.9%) while a previous diagnosis with prediabetes was reported in 6.9% of individuals (95% CI, 3.6-12.9%). The study authors used a combined measure for “prediabetes” or “diabetes risk” awareness due to potential unreliability of the point estimate of prediabetes awareness (relative standard error greater than 30%). Of youth with elevated HbA1c, the combined awareness was present in 26.5% (95% CI, 20.0%-34.2%), significantly higher compared to individuals with normal HbA1c (P = .001).

An increase in TV watching was associated with risk perception,“ (β = 0.3 hours per day [95% CI, 0.2-0.5 hours per day]) and approximately 1 less day per week with at least 60 minutes of physical activity (β = −1.2 [95% CI, −2.0 to −0.4) but not with nutrition or weight loss attempts,” the study states. Households with 5 members or more, compared to households with 1 or 2 members, reported lower consumption of non-home-prepared meals (OR 0.4 [95% CI, 0.2-0.7]) and lower screen time (β = −1.1 hours per day [95% CI, −2.0 to −0.3 hours per day). Public insurance, compared to private, was associated with fewer minutes per day of physical activity (β = −20.7 minutes per day [95% CI, 35.5 to −5.8 minutes per day]).

Results from this nationally representative, cross-sectional study, demonstrated that a healthier lifestyle was not associated with diabetes risk perception and awareness. According to the study authors, these findings highlight “that raising risk awareness alone may be insufficient to motivate behavior changes.” The findings of the study suggest more needs to be done to develop “evidence-based interventions that identify and reduce barriers to effective lifestyle change in youth.”


Chu P, Patel A, Helgeson V, Goldschmidt AB, Ray MK, Vajravelu ME. Perception and awareness of diabetes risk and reported risk-reducing behaviors in adolescents. JAMA Netw Open. 2023;6(5):e2311466. doi:10.1001/jamanetworkopen.2023.11466

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