Clinical, Behavioral, and Social Determinants of Cardiometabolic Risk in Adults with Prediabetes: A Cross-Sectional Study from NHANES

Abstract

Prediabetes is often thought of as a middle ground between normal and diabetic blood glucose levels but prediabetes carries more than just a glycemic diagnosis. The purpose of this article is to define clinical, behavioral, and social factors of cardiometabolic risk that are relevant to adults with prediabetes, based on peer-reviewed evidence from the National Health and Nutrition Examination Survey (NHANES) through December 31, 2023. The manuscript is a secondary cross-sectional analysis based on survey weighted NHANES data and no new estimates of the NHANES respondents are generated. Adults with prediabetes were found to have significant comorbidities in NHANES 2011-2014 – dyslipidemia (51.2%), hypertension (36.6%), current smokers (24.3%), albuminuria (7.7%), and reduced estimated glomerular filtration rate (EGFR) (4.6%) (Ali et al., 2018). Cardiometabolic profiles (CMP) in pooled NHANES 1999-2018 that were associated with adverse health behaviors or older age with low physical activity were more likely to have prediabetes than a younger, socially disadvantaged reference profile. Prevalence of prediabetes was also higher among adults with less than high school education (49.3%) compared with college graduates (37.0%) (fully adjusted prevalence ratio 1.14 [95% CI 1.02, 1.26]) . All of these results suggest that there is a multi-dimensional risk environment of prediabetes in which dyslipidemia, hypertension, smoking, inactivity, adiposity, educational disadvantage, economic conditions and healthcare access are interwoven. The evidence from cross sectional NHANES data suggests that clinical assessment of risk for cardiometabolic diseases goes beyond glycemia to risk factors, health behaviors and social barriers to prevention.