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Diabetes - Diagnosed Pre-diabetes Prevalence

Summary Indicator Report Data View Options

The prevalence of diagnosed pre-diabetes was statistically significantly higher in the years 2017 through 2020, than all years prior to 2016. As pre-diabetes continues to be under-diagnosed, the increase in prevalence may be due to a true increase in the prevalence of pre-diabetes or simply an improvement in testing and diagnosis, or some combination of the two. The prevalence of diagnosed pre-diabetes in NM was similar to that of the U.S. through 2017 but was statistically significantly higher in 2018 through 2020.
Diagnosed pre-diabetes is associated with age, the prevalence being higher in older age groups. Among males, the prevalence of diagnosed pre-diabetes was statistically significantly higher in the age groups, 55-64 and 65-74 years of age, than the younger age groups and the oldest age group. Among females, the prevalence of diagnosed pre-diabetes was higher among women in the older age groups but there was less difference between age groups. The two age groups, 55-64 and 65-74 were statistically significantly higher than younger age groups through age 44. Within each age group there was not a statistically significant difference between males and females.
There was no significant difference between Race/Ethnic groups.
Within each Race/Ethnic group, the rates for males and females were statistically similar with the exception of Hispanic adults. In this group, the prevalence of diagnosed pre-diabetes was statistically significantly higher in females than males.

Diagnosed Pre-diabetes Prevalence by County, New Mexico, Age-adjusted, 2018-2020

Household Income: Income and wealth influence the health of communities and individuals. Income is a powerful influence on one's ability to purchase nutritious food and to access health care. Though there was no statistically significant difference in diagnosed pre-diabetes by income group, it must be remembered that the true prevalence of pre-diabetes may be dramatically under-diagnosed and that access to health care will influence likelihood of diagnosis.
The 2018-2020 age-adjusted prevalence of diagnosed pre-diabetes education level. Education Level: Education level has a powerful impact on Income and wealth, which influence the health of communities and individuals. Education and income have a powerful influence on one's ability to purchase nutritious food and to access health care. Though there was no statistically significant difference in diagnosed pre-diabetes by education level, it must be remembered that the true prevalence of pre-diabetes may be dramatically under-diagnosed and that access to health care will influence likelihood of diagnosis.

Diagnosed Pre-diabetes Prevalence by Urban and Rural Counties, New Mexico, 2018-2020

Why Is This Important?

People with pre-diabetes have blood glucose levels higher than normal, but not high enough to be diagnosed as diabetes. The Centers for Disease Control and Prevention (CDC) states that without weight loss and physical activity, 15-30% of adults with pre-diabetes will develop diabetes within five years. People with pre-diabetes are also more likely to develop heart disease and stroke. It is very important that adults at risk of pre-diabetes be tested as there is great value in the ability to take action as early as possible. People who are diagnosed with pre-diabetes can learn about their condition and build the skills and confidence necessary to slow or prevent progression to diabetes. The U.S. Preventive Services Task Force (USPSTF) recommends screening for prediabetes and type 2 diabetes in adults ages 35 to 70 years who are overweight or have obesity. USPSTF notes that clinicians should offer or refer people with prediabetes to effective preventive interventions. USPSTF found convincing evidence that preventive interventions for people with prediabetes have a moderate benefit in reducing progression to type 2 diabetes. They also found adequate evidence that interventions for people with newly diagnosed diabetes have a moderate benefit in reducing the risk of death. (https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/screening-prediabetes-and-type-2-diabetes) It is important to keep in mind that there is reason to believe that pre-diabetes is dramatically under-diagnosed. Consequently, estimates of diagnosed pre-diabetes may not reflect the true prevalence of pre-diabetes.

Definition

Pre-diabetes prevalence is the estimated percentage of adult New Mexicans 18 years and older with diagnosed pre-diabetes. Age-adjusted to U.S. 2000 population (except for rates by age group).

Data Sources

  • Behavioral Risk Factor Surveillance System Survey Data, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, together with New Mexico Department of Health, Injury and Behavioral Epidemiology Bureau.
    (https://www.nmhealth.org/about/erd/ibeb/brfss/)
  • U.S. data source: Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion Chronic Disease Indicators, Behavioral Risk Factor Surveillance System (BRFSS) Data.
    (https://www.cdc.gov/cdi/)

How the Measure is Calculated

Numerator:Number of New Mexico adults (18 and older) who either responded, "Yes" to the BRFSS question: "Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes?" OR responded "No, pre-diabetes or borderline diabetes" to the core Diabetes Prevalence question "Have you ever been told by a doctor or other health professional that you have diabetes?"
Denominator:Number of New Mexico adults (18 and older) who responded to the BRFSS within the survey year.

How Are We Doing?

The BRFSS data provided here only identify NM adults with diagnosed pre-diabetes prevalence. However, we know that pre-diabetes is severely under-diagnosed across the nation and in New Mexico. According to the 2013-2016 National Health and Nutrition Examination Survey (NHANES), nationally, one in three American adults (34.5%) had pre-diabetes. However, only 15.3%, less than 2 out of 10 adults with pre-diabetes, were aware. Adjusting NM BRFSS estimates of diagnosed pre-diabetes by national NHANES estimates of diagnosed and undiagnosed pre-diabetes, an estimated 640,000 New Mexico adults had pre-diabetes in 2020. However, based on 2020 BRFSS rates of diagnosed pre-diabetes in NM (12.5%, not age-adjusted), between 3 and 4 out of 10 NM adults with pre-diabetes were aware of their condition. The 2020 national BRFSS estimate of diagnosed pre-diabetes was 10.0%. Adjusted for age, the NM and US 2020 estimates of diagnosed pre-diabetes were 11.9% and 9.3%, respectively. It is not known whether this difference reflects an actual difference in the prevalence of pre-diabetes or if it results from differences in screening.

How Do We Compare With the U.S.?

Since 2016, the prevalence of diagnosed pre-diabetes has been statistically significantly higher in New Mexico than in the U.S., as a whole. In previous years, there was no difference. As described above, about two-thirds of those with pre-diabetes were unaware that they have the condition. It is not known whether the recent increase in diagnosed pre-diabetes in NM is due to an increase in prevalence of the condition or simply improvements in testing and diagnosis. It will be very important to continue to monitor diagnosed pre-diabetes and NHANES estimates of the true prevalence. It is expected that improvements in testing and diagnosis will eventually bring the two estimates together, and, most importantly, will provide adults the information they need to make lifestyle changes that will delay or prevent progression to diabetes.

What Is Being Done?

The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers, community partners, agencies and coalitions to increase delivery of the National Diabetes Prevention Program (NDPP) throughout our state. The National Diabetes Prevention Program (NDPP), a one-year lifestyle balance curriculum developed by the CDC for adults with pre-diabetes, is based on the original Diabetes Prevention Program study that demonstrated that 5-7% weight loss achieved and maintained through regular, moderate physical activity and improved nutrition, prevented or delayed the progression of pre-diabetes to diabetes by 58% (71% for adults 60 years and older) compared to standard lifestyle recommendations. The DPCP is working to increase access to, and participation in, the NDPP across New Mexico by focusing on the following four strategies: 1) awareness; 2) availability and support; 3) screening, testing and referrals; and 4) coverage.

Evidence-based Practices

Diabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program's Lifestyle Change Program (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs (usually provided in a clinical setting). Engaging New Mexicans at high risk of diabetes with evidence-based prevention and management programs is proven to improve health outcomes and reduce the burden of diabetes including mortality. The following New Mexico Department of Health activities are in alignment with Centers for Disease Control and Prevention guidelines and best practices for diabetes control as recommended by the American Diabetes Association, The American Medical Association and the Association for Diabetes Care and Education Specialists: 1. Increase utilization of the National Diabetes Prevention Program's Lifestyle Change Program to prevent or delay the onset of type 2 diabetes among people at high risk by raising awareness about prediabetes, increasing Lifestyle Change Program delivery sites, facilitating the screening, testing and referral of eligible adults at high risk for diabetes to evidence-based programs, and increasing the participation of priority populations in Lifestyle Change Programs among Native American, Rural, Spanish-speaking and people experiencing disabilities or experiencing overweight/obesity. 2. Increase access to sustainable self-management education and support services, including Diabetes Self-Management Education Programs and Diabetes Self-Management Education and Support Programs to improve control of A1C, blood pressure, and cholesterol, by supporting delivery sites with resources to sustain programs, investing in referral systems to connect individuals from priority populations to programs and developing messaging and materials to reach diverse populations with culturally-relevant health promotion and outreach. 3. Implement evidence-based health systems interventions that support high-risk adults to prevent or manage diabetes and related chronic conditions, and help New Mexicans improve control of their A1C, blood pressure, and cholesterol. Health system interventions include initiating bi-directional referrals through electronic health records, the promoting utilization of A1C standing orders, expanding team-based care approaches to include Community Health Workers and creating workgroups with statewide clinical partners to provide trainings and technical assistance to implement health system interventions. 4 Identify and plan quality improvement activities with healthcare organizations that are working to improve health outcomes for people with and at risk for diabetes. Support healthcare organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements. 5. Promote the sustainability of Community Health Workers (CHWs) and Pharmacists involved in providing diabetes prevention, diabetes management and Medication Therapy Management services. 6. Indirectly support Nicotine Cessation programs.

Other Objectives

HP2020 objectives D-16 through D-16.3 focused on prevention of progression from pre-diabetes to diabetes by promotion of physical activity, reducing body weight among those who are overweight or obese, and improved nutrition. These objectives were dropped from HP2030. (https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes/objectives) In HP2030, only one objective focuses on Prediabetes, HP2030 D-02: Reduce the proportion of adults with undiagnosed prediabetes. (https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes/reduce-proportion-adults-who-dont-know-they-have-prediabetes-d-02)

Available Services

-Professional development opportunities provided by the New Mexico Diabetes Advisory Council, with continuing education credits, focusing on prediabetes and diabetes, and related chronic health conditions such as cardiovascular disease and obesity, as well as behaviors related to health, such as exercise and nutrition, or poor health, such as smoking. -Technical assistance to clinics and primary care providers to implement population-based strategies that support system changes that improve health outcomes (e.g. A1C, blood pressure, LDL cholesterol and smoking cessation) for New Mexico's most vulnerable populations. -Support for community-based prevention and management initiatives such as the National Diabetes Prevention Program, Diabetes and Chronic Disease Self-Management Programs, and Kitchen Creations cooking schools, for people with diabetes. -Analysis, interpretation, and dissemination of data on prediabetes, diabetes, cardiovascular disease, demographics, health behaviors, and access to health care. For more information on programs or services provided by the NM Department of Health, Diabetes Prevention and Control Program, go to https://www.nmhealth.org/about/phd/pchb/dpcp/.

More Resources

NM Department of Health, Diabetes Prevention and Control Program, go to https://www.nmhealth.org/about/phd/pchb/dpcp/. National Diabetes Prevention Program: https://www.cdc.gov/diabetes/prevention/Index.html Evidence-based lifestyle interventions for preventing type 2 diabetes for communities https://www.cdc.gov/diabetes/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fdiabetes%2Findex.htm 1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html 2. Diabetes Report Card: https://www.cdc.gov/diabetes/library/reports/reportcard.html Fact Sheets on Physical Activity: www.cdc.gov/nccdphp/sgr/fact.htm Diabetes Data and Trends: https://www.cdc.gov/diabetes/data/index.html 3. Guide To Community Preventive Services [information on community-level evidence-based practices]: Diabetes State Burden Toolkit: https://nccd.cdc.gov/Toolkit/DiabetesBurden National Diabetes Education Program www.ndep.nih.gov/ US Preventive Health Task Force (clinical preventive services) https://www.ncbi.nlm.nih.gov/books/NBK115115/?term=Preventive%20Health%20Task%20force 4. American Diabetes Association: https://www.diabetes.org/ 5. American Diabetes Association 2021 Standards of Care: https://professional.diabetes.org/content-page/practice-guidelines-resources 6. 2013-2016 National Health and Nutrition Examination Survey, National Center for Health Statistics. (https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf) 7. New Mexico Behavioral Risk Factor Surveillance System, 2011 through 2020.

Indicator Data Last Updated On 03/08/2021, Published on 05/09/2022
Diabetes Prevention and Control Program, New Mexico Department of Health, 810 W. San Mateo Road, Suite 200E, Santa Fe, NM 87505, Wayne Honey, Epidemiologist, wayne.honey@doh.nm.gov. Toll free: 1-888-523-2966