While most diabetic patients have a good grasp of their disease, their knowledge does not translate into healthy lifestyle choices, according to the results of a large survey released at the 71st Scientific Sessions of the American Diabetes Association (ADA).

The findings are from the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD), which is the largest nongovernmental longitudinal survey in the U.S.

"The results contradict the widely held notion that diabetics who are well informed about their disease and have good access to health care are likely to favorably alter their lifestyles per their physicians' recommendations," James Gavin III, MD, with Emory University School of Medicine in Atlanta, Georgia, said.

The analysis also revealed that information that adults can readily identify - such as age, family history, and obesity - are strong predictors for the onset of type 2 diabetes. Advancing age, for example, increased the likelihood of transition to frank diabetes by 300 to 500%. Obesity and excess abdominal fat boosted the risk by 50 to 100%.

For the study, investigators from multiple institutions nationwide analyzed responses to surveys distributed to a diverse population of U.S. adults, some of whom already had either type 1 or 2 diabetes. The screening survey was completed by 211,097 adults and the follow-up survey five years later was completed by 11,238 adults.

The data showed that 87% of 3,867 type 2 respondents in the baseline survey said that they knew that obesity can contribute to the onset of diabetes or exacerbate confirmed diabetes. However, while 70% of type 2 respondents said that they had tried to lose weight over the prior year, only 34% had maintained their goal weight for more than six months.

Most patients had been given exercise advice but were noncompliant. Specifically, 63% of type 2 respondents in the screening survey said that their primary care practitioner had recommended an increase in physical activity in the last 12 months however 87% said that they were inactive over the last seven days. About 20% of patients reported that they would rather take a medication for their health conditions than alter their lifestyle.

Diabetes and pre-diabetes are common in the U.S. According to the Centers for Disease Control and Prevention, 7 million of the 104.8 million Americans who are 20 years of age or older have undiagnosed diabetes and 18.8 million have a confirmed diagnosis of diabetes. The remaining 79 million individuals have impaired fasting glucose/impaired glucose tolerance/prediabetes.

Were the investigators surprised by the findings? "In my experience as a clinician 'in the trenches,' I have seen over and over again patients who aren't very well informed and educated and who don't change their behavior, and that's a common experience among all clinicians," Andrew Green, MD, a SHIELD investigator and an endocrinologist in private practice in Overland Park, Kansas, said. "Nevertheless, that runs counter to the 'party line' that education leads to change. And that's been to this day the dominant paradigm. So, in a sense, the data confirm my anecdotal impression that information is not sufficient."

The SHIELD study was funded by AstraZeneca.

Written by Jill Stein
Jill Stein is a Paris-based freelance medical writer.