OBJECTIVES:Previous research identified gaps between evidenced-based prediabetes treatment guidelines and implementing them in practice. This study aimed to examine the influence of health care provider instruction on lifestyle behavior change known to reduce the risk of diabetes in US adults with prediabetes.

METHODS: This study sample was derived by pooling two cycles of the US National Health and Nutrition Examination Survey (NHANES, 2013-2014 and 2015-2016). Adults with prediabetes identified by A1C or glucose level were included and then divided into two groups: those receiving instruction from a provider about lifestyle change vs. no instruction (i.e., control or lose weight, increase exercise, or reduce fat or caloric intake). Outcomes included the prevalence of those receiving instruction and patterns of behavioral lifestyle change in the NHANES participants with prediabetes. Logistic regression models examined associations between receiving instruction and lifestyle behavior, adjusting for demographics, and health-related characteristics. Four-year examination weights were constructed and applied to all analyses to obtain national estimates for the US population.

RESULTS: This study sample included 3591 eligible adults with prediabetes. Of those 48.1% (n=1703) received a provider’s advice about lifestyle change. The instruction group reported higher proportions of ongoing lifestyle change vs. no instruction to include weight reduction/control (76.2% vs. 55.2%, p<0.001), exercise (63.3% vs. 49.7%, p<0.001), and diet (77.3% vs. 45.4%, p<0.001). After covariate adjustment, the instruction group was more likely to modify lifestyle to reduce the risk for diabetes, including weight reduction/control (OR=1.78, 95% CI: 1.46, 2.17), exercise (OR=1.90, 95% CI: 1.55, 2,32), and diet (OR=3.08, 95% CI: 2.47, 3.83).

CONCLUSIONS: In the US, less than 50% of adults with prediabetes received instruction from a health care provider about reducing the risk of diabetes through lifestyle change. The provider’s advice about lifestyle change increases the likelihood that adults with prediabetes change lifestyle-related behavior.