When Should "Pre" Carry as Much Weight in the Diabetes Comorbidity Debate?

Insights From a Population-Based Survey

Negin Iranfar, MPH; Tyler C. Smith, MS, PhD


Prev Chronic Dis. 2018;15(3):e36 

In This Article

Abstract and Introduction


Introduction Estimates indicate that 86 million people in the United States fit the clinical definition of prediabetes, which contributes to the epidemic of nearly 2 million new diagnoses of type 2 diabetes mellitus each year. Effort has focused on preventing prediabetes from progressing to clinical diabetes. We investigated the sociodemographic, behavioral, and health factors in people diagnosed with diabetes or prediabetes and associated leading indicators and comorbidities.

Methods We used Behavioral Risk Factor Surveillance System data from 2011 through 2015 (N = 1,699,754). All respondents aged 18 years or older with complete covariate data were included, differentiating between self-reported diagnosis of diabetes or prediabetes. Weighted univariate and multivariable logistic regression analyses of 28 variables were developed, with adjusted odds of diagnosis, and standardized coefficients were calculated to rank predictors for diabetes and prediabetes.

Results Prevalence of prediabetes increased each year between 2011 and 2014. After adjusting for demographic, lifestyle, and health variables, the most significant predictors in magnitude of importance for prediabetes and diabetes were age and body mass index. Although adjusted odds for cardiovascular disease and kidney disease were higher in respondents with diabetes than in those with prediabetes, respondents with prediabetes had higher adjusted odds of arthritis, depressive disorder, cancer, and chronic obstructive pulmonary disease.

Conclusions Concurrent chronic diseases occur in people with prediabetes even at normal and overweight classifications. By identifying the conditions that are concomitant with diabetes, people with prediabetes can be provided with more rigorous and individualized treatments that can lead to better population health.


Type 2 diabetes mellitus is a multifactorial chronic condition caused by defects in the metabolic system relating to insulin secretion and insulin resistance.[1] According to the Centers for Disease Control and Prevention (CDC), an estimated 1.7 million incident cases of diabetes among Americans aged 20 years or older were reported in 2012, an equivalent of 4,657 daily cases.[2] In 2014, the World Health Organization estimated that 387 million people worldwide have type 2 diabetes, with half as many cases still undiagnosed, projecting prevalence of type 2 diabetes at 592 million by 2035.[3]

The global epidemic of type 2 diabetes was predicted as early as 1971, as the result of a rapid increase in the prevalence of this disease among indigenous populations who adopted Western lifestyles.[4,5] Over the past 4 decades, many epidemiological studies demonstrated that the Western way of life has contributed to the increased prevalence of type 2 diabetes and its complications.[6–8] Prediabetes is an early stage of dysglycemia that occurs before diagnosis of overt diabetes.[9] According to CDC, as of 2014, one in 3 adults older than 20 years [86 million people] had clinical prediabetes, with an estimated 8% to 12% diagnosed;[2,10] without any intervention to treat prediabetes through lifestyle modification, medication, or both, 5% to 10% of them will progress to type 2 diabetes each year, compared with 2% of normoglycemic people.[2,9,11] We used data from a large, representative, cross-sectional national survey to investigate the trend in type 2 diabetes and prediabetes from 2011 through 2015 in the United States.