Diabetes risk perception in overweight adults in East Harlem

Pre-diabetes is highly prevalent and associated with increased cardiovascular disease and all cause mortality. Up to 70% of pre-diabetics will develop diabetes. More accurate risk perception may encourage lifestyle (dietary and physical activity) changes and weight loss proven to prevent diabetes in over 50% of adults with pre-diabetes. Underestimation of risk might inhibit preventive behaviors and, therefore, be a target for behavioral interventions. We used a community-based participatory approach to recruit overweight adults in East Harlem with no known diabetes, measure their body mass index, used oral glucose tolerance testing to determine if they had pre-diabetes, and surveyed them regarding perceptions of health, diabetes risk and personal medical history. Those recruited (n=578) were predominantly young (mean age 44 years), female (84%), Latino (74%), Black (22%), uninsured (44%), undereducated (44% with less than high school education), and had hypertension (28%), hyperlipidemia (29%), and heart disease (10%). While only one-third (31%) had a heightened diabetes risk perception, more than half (53%) perceived themselves to have good health, 60% were obese, 63% had pre-diabetes, and 43% met criteria for diagnosis of metabolic syndrome. Heightened diabetes risk perception was significantly associated (p<0.05) with being obese, having a family history of diabetes, and the perception of being overweight and having poorer heath. Most overweight adults surveyed had good self-rated health and few felt they were at increased risk for diabetes, yet most were obese and already had pre-diabetes. Interventions should be tested that impact risk perception to encourage the lifestyle modification proven to prevent diabetes.