Study highlights need for lifestyle change awareness in at-risk

In a recent study published in JAMA Network Open, researchers in the United States assessed associations between diabetes risk awareness/perception and adolescent health behaviors.

The prevalence of prediabetes in adolescents has doubled in the last two decades, which affects around 40% of obese youth. Type 2 diabetes (T2D) onset in youth causes microvascular complications within two decades of diagnosis in most affected individuals. The primary treatment is lifestyle changes because no medicine has shown a reduction in prediabetes to T2D progression in youth.

A study involving prediabetic adults observed that individuals aware of their diagnosis were likely to engage in behaviors to mitigate risks, although others report mixed findings. Adolescents’ perceptions of and responses to health risks differ from adults. If risk perception and awareness in adolescents are associated with positive changes in health behavior, this could serve as a basis for recognizing and diagnosing prediabetes.

Study: Perception and Awareness of Diabetes Risk and Reported Risk-Reducing Behaviors in Adolescents. Image Credit: DONOT6_STUDIO / Shutterstock

About the study

The present study evaluated whether perception and awareness of diabetes risk and potential barriers to health behavior changes were associated with risk-mitigating health behaviors in at-risk adolescents. The researchers included adolescents aged 12-17 with a body mass index (BMI) in the 85^th percentile or higher for sex and age, with data on glycated hemoglobin (HbA1c) measurements from the United States (US) National Health and Nutrition Examination Survey.

Participants were excluded if they had diabetes or did not respond to survey questions related to diabetes risk. They completed questionnaires on nutrition, weight, physical activity, and diabetes. The diabetes questionnaire was used to evaluate risk perception/awareness. Measures of household size and food security, healthcare access, health insurance, and income were included to identify potential barriers to changes in health behavior.

Outcome measures included physical activity, frequency of weight loss attempts, sedentary time, and consumption of non-home-prepared meals. Sedentary time was evaluated as hours spent watching television or using video games and computers for non-academic activities. Logistic and linear regression models examined associations between risk-reducing behaviors and risk perception, awareness, and potential barriers.

Findings

The study included 1341 individuals with an average age of 15 and a BMI z-score of 1.76. HbA1c levels were elevated in 9% of the cohort; of these, one-third reported being at risk for diabetes, significantly higher than those with normal HbA1c levels. Diabetes risk perception was higher in individuals aged 16-17 than among 12-15-year-old participants. Over 22% of participants with elevated HbA1c reported diabetes risk awareness, and about 7% reported a prior prediabetes diagnosis.

The combined awareness of the risk of diabetes and prediabetes was higher among participants with increased levels of HbA1c than those with normal levels. Risk awareness was not different between the 12-15 and 16-17 age groups. The perception/awareness of diabetes risk was not associated with the consumption frequency of fast food and frozen or non-home-cooked meals. Potential barriers, such as food insecurity, public insurance, and larger household size, were associated with nutrition-related positive health behaviors.

After adjusting for confounders (age, sex, ethnicity/race, BMI z-score, and hyperglycemia), advanced age was associated with 30%-40% elevated odds of consuming at least four fast food/non-home-cooked meals in the last week. In contrast, females had 40% reduced odds of consuming at least four pizzas or frozen meals in the previous 30 days.

Risk perception was associated with increased screen time and fewer days of physical activity in the past week, whereas risk awareness was not associated with sedentary time or physical activity. After confounder adjustment, risk perception was associated with increased television watching and one less day of physical activity. Larger households and female sex were associated with reduced screen time. A higher BMI z-score was associated with increased screen time.

Conclusions

Taken together, the researchers observed no associations between perception/awareness of diabetes risk and health behaviors to reduce diabetes risk among US adolescents at-risk of T2D due to high BMI. However, risk perception was associated with increased television watching and fewer days of physical activity.

Some potential barriers were related to negative health behavior patterns. In contrast, others appeared protective, such as lower consumption of non-home-cooked meals and less television time among individuals from larger households. Further research is required for evidence-based interventions to identify and decrease barriers to effective lifestyle changes in youth.