ShareSocial and cultural factors mean that people who are told they are pre-diabetic are too often unable to make the necessary lifestyle changes to prevent progression to diabetes, according to a study by researchers supported by the NIHR oxford Biomedical Research Centre.
The study, ‘How are health-related behaviours influenced by a diagnosis of ‘pre-diabetes’? A meta-narrative review’, was published in BMC Medicine on Friday 27 July.
Diabetes prevention is a national priority in the UK, where 4 million people affected by the condition. The cost of treating diabetes and its complications is estimated to be £23.7billon, or 10% of the NHS budget.
Policymakers are particularly interested in targeting preventive efforts towards people with ‘pre-diabetes’, where the level of glucose in the blood is higher than normal but not yet high enough to count as diabetic. These individuals may be able to prevent progression to full-blown diabetes by losing weight and increasing their exercise levels.
The team of researchers at Oxford University’s Nuffield Department of Primary Care Health Sciences reviewed the academic literature, to see what happened to people who were told they had ‘pre-diabetes’. The team included the NIHR Oxford BRC Theme Lead for Partnerships for Health, Wealth and Innovation, Prof Trish Greenhalgh, and Co-theme Lead Prof Nick Fahy.
“We found that providing knowledge about the risks of pre-diabetes did not always – or even usually – lead to changes in lifestyle in people with pre-diabetes,” Prof Greenhalgh said.
“For behaviour change, people needed to have material resources, such as being able to pay for healthy food options, gym membership, as well as social support from friends and family, and being able to navigating the norms and expectations of their cultural and religious group.”
The study found that those who had multiple disadvantages, such as poor housing, low income, absent social support or conflicting cultural norms found it much harder to achieve the kind of lifestyle changes necessary to prevent diabetes.
“These findings are important because diabetes is much commoner in people from low-income and minority ethnic backgrounds,” Prof Greenhalgh said.
“Our findings suggest that additional work will need to be done to address the wider material and environmental influences on health, to ensure that the National Diabetes Prevention Programme achieves its goal of preventing a significant proportion of new cases of diabetes.”
The National Diabetes Prevention Programme is providing individual lifestyle education for people found to have pre-diabetes.
The meta-analysis found that study of pre-diabetes to date has involved at least three research disciplines (biomedicine, psychology and sociology), which have operated largely independently of one another.
The study concluded that: “Behavioural science and sociology are increasing our understanding of how personal, social, cultural and economic aspects influence health-related behaviours. An interdisciplinary approach with theoretically informed multi-level studies could potentially improve the success of diabetes prevention strategies.”