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 between 5.7% to 6.4% 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 the 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 and Human Services (DHHS) has been working to increase awareness of prediabetes. In 2016, 5.2% of adults reported they had been told by a health care provider that they had prediabetes (crude rates). Data collected in 2020 (Behavioral Risk Factor Surveillance System) showed this percentage increased to 10.2% (crude rates). While this increased rate may be partly due to a true increase, it likely reflects increased awareness by providers and patients.

How Do We Compare With the U.S.?

Adults in the U.S. generally have a similar rate of being diagnosed with prediabetes than adults in Utah. National data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) indicated that 11.9% (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 11.1% (age- adjusted) of adults have been told by a provider that they have prediabetes (BRFSS 2020). The actual percentages 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 2015, DHHS received funding to increase awareness and prevention of prediabetes. National data suggest that many individuals have prediabetes but have not been diagnosed by a healthcare provider and are not aware they have it due to its unclear symptoms. DHHS is working to increase awareness of this condition among health care providers, as well as individuals at risk by promoting and supporting different programs that target different stages of diabetes prevention.

Evidence-based Practices

The 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 6 additional follow-up sessions (for a total of 22 or more sessions). DPRP-recognized programs submit reports to DPRP every 6 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 [https://diabetes.org/ website]. [https://www.niddk.nih.gov/health-information/community-health-outreach/information-clearinghouses?dkrd=hisce0003 The National Diabetes Education Program] has resources for diabetes management for professionals, businesses, and patients. Most materials are available upon request at no charge. [https://www.cdc.gov/diabetes/prevention/index.html The National Diabetes Prevention Program] has resources for diabetes prevention for employers, insurers, health care professionals, program providers, and individuals. You can find and enroll in the National Diabetes Prevention Program, an evidence-based health program for prediabetes [https://heal.health.utah.gov/compass/#/?distance=30&programId=group_2 here]. [https://dhhs.utah.gov/ The Utah Department of Health and Human Services] has a Health Resource hotline: 1-888- 222-2542. Please call this number or 211 for information about self-management programs in Utah. The [https://heal.health.utah.gov/ HEAL website] provides information on diabetes self-management classes. [https://www.diabeteseducator.org/ Association of Diabetes Educators] 800-338-3633 [https://www.heart.org/ American Heart Association] 1937 S. 300 W. #120 Salt Lake City, UT 84115 (801) 484-3838 or 1-800-242-8721

Health Program Information

The Utah Department of Health and Human Services, Healthy Environments Active Living program plays a key role in improving the health of residents in the state of Utah. The program was formed in July 2013 (as EPICC), through a new funding opportunity from the Centers of Disease Control and Prevention (CDC) that allowed for the merging of three previously existing programs: the Heart Disease and Stroke Prevention Program, the Diabetes Prevention and Control Program, and the Physical Activity, Nutrition and Obesity Program, as well as the addition of a school health program. The Healthy Environments Active Living Program (HEAL) was recently restructured as part of this strategic planning process and the new program model focuses on working together with staff and partners to address the social determinants of health while advancing health equity and increasing policy, systems and environment changes. HEAL champions public health initiatives and addresses the challenges of making health awareness and access truly universal and equitable in eight key areas: nutrition, heart health, diabetes, physical activity, schools, child care, community health workers, and worksites. Visit [https://heal.health.utah.gov/ HEAL?s website] for more information.

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. Take [https://utahgov.co1.qualtrics.com/jfe/form/SV_1BxUAHdVBKi42Sa this online quiz] to see if you are at risk for prediabetes.

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 showed that weight loss and participation in regular physical activity can significantly decrease the risk of diabetes . The 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% 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 [https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp?dkrd=prspt1922 Diabetes Prevention Program, NIH]). 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 kidney disease. Diabetes can affect both physical and mental health. Complications from diabetes can have a significant impact on quality of life. 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 2020, the Utah adult prediabetes rate (11.1%) was similar to the U.S. rate (11.9%).

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase the 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]] Prediabetes questions were not asked in Utah in 2015 or 2019. Age-adjusted to U.S. 2000 standard population. U.S. data does not include U.S. territories, but does include Dist. of Columbia. 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 the 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 Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.health.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

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 the 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 Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.health.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

Hispanic adults had higher rates of diagnosed prediabetes than non- Hispanic adults, however the difference is not statistically significant.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase the 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.

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

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase the 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.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.health.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

Generally, prediabetes rates are similar across education levels.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase the 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. 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 Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.health.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

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 the 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.

Data Source

Utah Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.health.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

The following small areas have statistically lower rates of prediabetes than the state: Syracuse, Millcreek (East), Sandy (Northeast), Pleasant Grove/Lindon, Mapleton, Park City, Duchesne County, Central (Other), Emery County, St. George, and Washington City. The following small areas have statistically higher rates of prediabetes than the state: Ben Lomond, Ogden (Downtown), Roy/Hooper, Salt Lake City (Rose Park), West Valley (Center), West Valley (East), Kearns, Taylorsville (West), and Tooele Valley.

Data Notes

In 2016, Utah BRFSS modified its methodology for age adjustment to increase the 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 Department of Health and Human Services Behavioral Risk Factor Surveillance System (BRFSS) [https://ibis.health.utah.gov/ibisph-view/query/selection/brfss/BRFSSSelection.html]

References and community resources

American Diabetes Association http://www.diabetes.org Diabetes Prevention Program National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram Division of Diabetes Translation, Centers for Disease Control and Prevention http://www.cdc.gov/diabetes Association of Diabetes Care and Education Specialists: https://www.diabeteseducator.org/ Information on registering for self-management prediabetes and diabetes programs can be found [https://heal.health.utah.gov/compass/#/?distance=30&programId=group_2 here]. Diabetes treatment resources: https://www.utahinsulin.net Insulin access: https://getinsulin.org/ Access & Affordability Resources: Association for Diabetes Care & Education Specialists (ADCES) https://www.diabeteseducator.org/home