DefinitionPre-diabetes prevalence is the estimated percentage of adult New Mexicans 18 years and older with diagnosed pre-diabetes.
NumeratorNumber of New Mexico adults (18 and older) who either responded, "Yes" to the BRFSS question: "Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes?" OR responded "No, pre-diabetes or borderline diabetes" to the core Diabetes Prevalence question "Have you ever been told by a doctor or other health professional that you have diabetes?"
DenominatorNumber of New Mexico adults (18 and older) who responded to the BRFSS within the survey year.
Data Interpretation IssuesData for this indicator report are from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing survey of adults regarding their health-related behaviors, health conditions, and preventive services. Data are collected in all 50 states, D.C., and U.S. territories. Responses have been weighted to reflect the New Mexico adult population by age, sex, ethnicity, geographic region, marital status, education level, home ownership and type of phone ownership. U.S. value is the median value of 50 states and D.C.
The survey is conducted using scientific telephone survey methods for landline and cellular phones (with cellular since 2011). The landline phone portion of the survey excludes adults living in group quarters such as college dormitories, nursing homes, military barracks, and prisons. The cellular phone portion of the survey includes adult students living in college dormitories but excludes other group quarters.
Beginning with 2011, the BRFSS updated its surveillance methods by adding in calls to cell phones and changing its weighting methods. These changes improve BRFSS' ability to take into account the increasing proportion of U.S. adults using only cellular telephones as well as to adjust survey data to improve the representativeness of the estimates generated from the survey. Results have been adjusted for the probability of selection of the respondent, and have been weighted to the adult population by age, gender, phone type, detailed race/ethnicity, renter/owner, education, marital status, and geographic area. Lastly and importantly, these changes mean that the data from years prior to 2011 are not directly comparable to data from 2011 and beyond. Please see the [https://ibis.health.state.nm.us/view/docs/Query/BRFSS/BRFSS_fact_sheet_Aug2012.pdf BRFSS Method Change Factsheet].
The "missing" and "don't know" responses are removed before calculating a percentage.
Why Is This Important?People with pre-diabetes have blood glucose levels higher than normal, but not high enough to be diagnosed as diabetes. The Centers for Disease Control and Prevention (CDC) states that without weight loss and physical activity, 15-30% of adults with pre-diabetes will develop diabetes within five years. People with pre-diabetes are also more likely to develop heart disease and stroke.
It is very important that adults at risk of pre-diabetes be tested as there is great value in the ability to take action as early as possible. People who are diagnosed with pre-diabetes can learn about their condition and build the skills and confidence necessary to slow or prevent progression to diabetes.
Healthy People Objective: D-16, Increase prevention behaviors in persons at high risk for diabetes with pre-diabetesU.S. Target: Not applicable, see subobjectives in this category
Other ObjectivesHP2020 objectives D-16 through D-16.3 focus on prevention of progression from pre-diabetes to diabetes by promotion of physical activity, reducing body weight among those who are overweight or obese, and improved nutrition.
How Are We Doing?The BRFSS data provided here only identify NM adults with diagnosed pre-diabetes prevalence. However, we know that pre-diabetes is severely under-diagnosed across the nation and in New Mexico. According to the 2012-2014 National Health and Nutrition Examination Survey (NHANES), one in three American adults (33.4%) had pre-diabetes (although fewer than 3 out of 10 adults with pre-diabetes had been previously diagnosed).
Applying NHANES estimates to the New Mexico population, nearly half a million NM adults were estimated to have pre-diabetes in 2017. However, based on 2017 BRFSS rates of diagnosed pre-diabetes in NM (10.1%), only about 3 out of 10 NM adults with pre-diabetes were aware of their condition. The 2017 national BRFSS estimate of diagnosed pre-diabetes was 8.4%.
How Do We Compare With the U.S.?Since 2016, the prevalence of diagnosed pre-diabetes has been statistically significantly higher in New Mexico than in the U.S., as a whole. In previous years, there was no difference. As described above, about two-thirds of those with pre-diabetes are unaware that they have the condition. It is not known whether the recent increase in diagnosed pre-diabetes in NM is due to an increase in prevalence of the condition or simply improvements in testing and diagnosis. It will be very important to continue to monitor diagnosed pre-diabetes and NHANES estimates of the true prevalence. It is expected that improvements in testing and diagnosis will eventually bring the two estimates together, and, most importantly, will provide adults the information they need to make lifestyle changes that will delay or prevent progression to diabetes.
What Is Being Done?The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers, community partners, agencies and coalitions to increase delivery of the National Diabetes Prevention Program (NDPP) throughout our state.
The NDPP, a one-year lifestyle balance curriculum developed by the CDC for adults with pre-diabetes, is based on the original Diabetes Prevention Program study that demonstrated that 5-7% weight loss achieved and maintained through regular, moderate physical activity and improved nutrition, prevented or delayed the progression of pre-diabetes to diabetes by 58% (71% for adults 60 years and older) compared to standard lifestyle recommendations.
The DPCP is working to increase access to, and participation in, the NDPP across New Mexico by focusing on the following four strategies: 1) awareness; 2) availability and support; 3) screening, testing and referrals; and 4) coverage.
Evidence-based PracticesDiabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program or NDPP (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program or DSMEP (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs or DSME/S (usually provided in a clinical setting). Improving the quality of clinical care for people with and at risk for diabetes is also an evidence-based practice. The following DPCP activities are in alignment with these accepted programs and practices:
1. Increase use of the NDPP to prevent or delay onset of type 2 diabetes among people at high risk by raising awareness about pre-diabetes and the NDPP, increasing delivery sites, facilitating the screening and referral process, and working to obtain health insurance coverage (including Medicaid) for the program.
2. Increase access to sustainable self-management education and support services (DSMEP and DSME/S) to improve control of A1C, blood pressure, and cholesterol, and to promote tobacco cessation, by increasing delivery sites, facilitating the referral process, and working to obtain health insurance coverage (including Medicaid) for the programs.
3. Implement evidence-based worksite programs and policies that help people prevent or manage diabetes and related chronic conditions, promote tobacco cessation, and help employees improve control of their A1C, blood pressure, and cholesterol.
4. Improve health outcomes for people with and at risk for diabetes by supporting health care organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements.
5. Promote the sustainability of Community Health Workers (CHWs) involved in providing diabetes prevention and management services.