Family history of diabetes is linked to more awareness, less fatalism, but no differences in physician counseling behavior among minorities with high diabetes risk

Objective: Family history is a powerful risk factor for diabetes. The objective of this study was to assess overweight adults' perceived risk for diabetes and their physicians' roles in defining preventive strategies as part of a community-academic partnership in East Harlem. Methods: Using a community-based participatory research approach, we recruited overweight adult residents of East Harlem with no known diabetes. They were asked about their family history, the three most powerful risk factors for diabetes, and about advice that they had received from their primary care providers regarding their weight, diet and exercise. Bivariate analysis and multivariate models were run to assess the relationship between family history of diabetes and knowledge of perceived risk factors for diabetes, fatalism and providers' counseling regarding diabetes risk factors.

Results: The final cohort was predominately low-income (47% <$5,000), female (84%) and Latino (74%). Fifty-six percent had a family history of diabetes. Respondents listed unhealthy eating (67%), being overweight (47%), being physically inactive (38%) and having a family history of diabetes (32%) as the most powerful risk factors for diabetes. Nearly a quarter could not name any risk factor for diabetes. Those with a family history were more likely to identify family history as a risk factor for diabetes (35% vs. 28%; p=0.04) and less likely to agree with the statement, “If you are going to get diabetes, there is not much you can do about it” (56% vs. 47%; p=0.02). Among the 76% of participants with a regular health care provider, two thirds had been informed by their physicians that they needed lose weight, be more active, and eat healthier. Multivariate models suggested that physicians did not counsel patients differently whether or not they had a family history of diabetes.

Conclusions: In a cohort of overweight participants who had not received a diagnosis of pre-diabetes or diabetes, those with a family history of diabetes were more likely to accurately report family history as a risk factor. Although the relationship could have gone either way, individuals with a family history were less fatalistic about their ability to prevent diabetes onset. Nevertheless, physicians did not adjust their counseling based on whether an individual had a family history of diabetes. Clinicians should consider eliciting this history and determining whether tailored counseling for those with a diabetes family history will better engage this high risk group in diabetes prevention activities.