CHICAGO — Few adults with diabetes and prediabetes are adhering to American Diabetes Association nutrition and activity recommendations, and even fewer with undiagnosed diabetes are doing so.
After adjustment for age, gender, and race, a logistic regression analysis of 6,446 U.S. adults revealed that only a small proportion of those with diabetes (40.2%), undiagnosed diabetes (31.5%), prediabetes (40.7%), and normal glucose (41.4%) were meeting at least three out of five American Diabetes Association (ADA) dietary recommendations.
Similarly, the proportion of adults reporting physical activity of 150 minutes or more per week was low at 19.6%, 24.6%, 21.4%, and 26.3%, respectively, Dr. Yiling J. Cheng of the division of diabetes translation at the Centers for Disease Control and Prevention, and colleagues reported in a poster at the annual scientific sessions of the ADA.
The investigators analyzed self-reported dietary and physical activity information from adults aged 20–79 years in the National Health and Nutrition Examination Survey (NHANES) 1999–2004 database. The cohort included 1,333 adults with self-reported diagnosed diabetes, 180 with undiagnosed diabetes defined by a fasting glucose of 126 mg/dL or more, 1,459 adults with prediabetes defined by a fasting glucose between 110 and 125 mg/dL, and 3,474 adults with a normal fasting glucose of less than 100 mg/dL.
The median age was 43 years; 62% were women, 72% were non-Hispanic white, 11% black, and 13% Hispanic.
The 2002 ADA guidelines used in the study recommend the following:
▸ Carbohydrate and monosaturated fat together provide 60%–70% of total energy intake.
▸ Saturated fats contribute less than 10% of energy intake.
▸ Dietary cholesterol is less than 300 mg/day.
▸ Total fat intake is less than 30% of daily energy.
▸ Daily sodium intake is no more than 2,400 mg.
▸ Thirty minutes or more of physical activity 5 or more days per week.
The best adherence was observed for cholesterol, with 64.4% of those with diabetes, 53.4% with undiagnosed diabetes, 61.9% with prediabetes, and 65.2% with normal glucose levels meeting the daily target. Conversely, adherence to the total daily fat intake was poor at 31%, 24.5%, 30%, and 33.2%, respectively.
The study did not evaluate obstacles to adherence, but lack of knowledge, reluctance to change, and socioeconomic status are known barriers. How the guidelines are translated to the general public also may play a role, Dr. Cheng said. For example, it's hard for patients to know what 2,000 mg of sodium looks like without further knowledge.
“These recommendations seem to be quantified, but hard to be practiced or followed by the general population,” Dr. Cheng said in an interview. “A layman's recommendation may be helpful.”
Improvements in early detection of diabetes, guideline dissemination, and education should also be considered, the authors noted.
The ADA has released several versions of dietary and physical activity guidelines, with the latest guidelines published last year (Diabetes Care 2006;29:2140-57).
Compared with the 2002 guidelines, the new guidelines for persons with diabetes call for more sodium restriction (less than 2,000 mg/day), lower dietary cholesterol (less than 200 mg/day), and less saturated fats (less than 7% of energy intake), Dr. Cheng noted.