Executive Summary

The National Diabetes Education Program
National Diabetes Survey
Trends and Findings (2006, 2008, 2011):
Executive Summary
December 1, 2012

National Diabetes Education Program
National Institutes of Health
Bldg. 31, Room 9A06
31 Center Drive
Bethesda, MD 20892

Acronyms
BP
CATI
CDC
CVD
DHHS
HCP
NDEP
NIDDK
NIH
NNDS
OMB
PAR
PWD
RDD
U.S.

Blood pressure
Computer-assisted telephone interview
Centers for Disease Control and Prevention
Cardiovascular disease
U.S. Department of Health and Human Services
Health care professional
National Diabetes Education Program
National Institute of Diabetes and Digestive and Kidney Diseases
National Institutes of Health
NDEP National Diabetes Survey
Office of Management and Budget
People at risk
People with diabetes
Random digit dialing
United States

NDEP National Diabetes Survey

FINAL—December 1, 2012

Executive Summary
Background
To measure diabetes-related knowledge, attitudes, and practices among adults in the United
States, the National Diabetes Education Program (NDEP) periodically conducts the NDEP
National Diabetes Survey (NNDS). Findings from this nationwide telephone survey help to
assess the program’s progress and inform NDEP strategic planning.
This report presents trends and findings for three rounds of the NNDS: 2006, 2008, and 2011.
Each of the surveys was nationally representative of the U.S. civilian, non-institutionalized adult
population living in households that had landline telephones. All used consistent methodology
and wording of questions to allow examination of trends over time. Computer-assisted
telephone interviews were conducted in English or Spanish, depending on the survey
respondent’s preference.
Please keep in mind:
• Questionnaire items were developed in 2006 and remained largely unchanged in 2008
and 2011 so that responses could be compared over time. Results are presented using
the questionnaire language; as a result, some terminology does not reflect the most
current understanding and knowledge of diabetes.
• Question responses reflect people’s perceptions at the time each survey was
conducted, and there are no right or wrong answers.
• Except for those who reported that they were diagnosed by a health professional as
having diabetes or prediabetes, people did not necessarily know their diabetes status
at the time of the survey. They were categorized for analysis as having prediabetes or
being at risk based on their responses to a series of questions.
• All percentages are weighted unless otherwise noted.
In 2006, the 1,763 respondents who completed the survey were adults ages 45 years and older.
In 2008 (n = 2,078) and 2011 (n = 2,234), the age range was expanded to include adults from 35
to 44 years of age, as research showed that the rate of type 2 diabetes was growing fastest
among adults in that age group. Each time the survey was administered, African Americans and
Hispanics were oversampled to ensure adequate representation of these groups. Response
rates were 44 percent in 2006, 54 percent in 2008, and 30 percent in 2011. Each survey’s
responses were weighted to reflect unequal selection probabilities and the race/ethnicity,
gender, age, education, and marital status of the U.S. population.
Respondents’ diabetes status categories used in this report were not self-reported categories.
They were assigned after an interview based on information collected during the interview.
•

People with diabetes (PWD) had been told by a doctor or other health professional that
they had diabetes or sugar diabetes.

NDEP National Diabetes Survey

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•

People with prediabetes had been told by a doctor or other health professional that
they had prediabetes, impaired fasting glucose, impaired glucose tolerance, borderline
diabetes, or high blood sugar.

•

People at risk (PAR) whose self-reported height and weight gave them a body mass
index of 25 or greater had been told by a doctor or other health professional that they
were at high risk for diabetes, or had been told by a health care professional that they
had gestational diabetes or high blood sugar during pregnancy.

•

All others met none of the above criteria.

Key Findings
The three surveys reveal trends in five areas that can inform future efforts to prevent and
manage diabetes and its complications:
•
•
•
•
•

Awareness of diabetes terminology and knowledge of diabetes facts
Perceived risk of diabetes
Awareness of family history as a diabetes risk factor
Comorbidities associated with diabetes
Diabetes management

Trends reported here are among all respondents age 45 and older (the age range included in all
three surveys), unless otherwise noted.
Awareness of diabetes terminology and knowledge of diabetes facts. In a very short time,
American adults have made significant advances in their knowledge and awareness of diabetes
and prediabetes. In 2011:
•

Over three-fourths of respondents (77%) were aware that type 2 diabetes is preventable
(65% in 2006).

•

More than half of respondents (57%) had heard the term “prediabetes” (45% in 2006).

•

More than one-third (37%) of all respondents had heard of “glycosolated hemoglobin or
A1C” (up from 31% in 2006).

•

A growing proportion of respondents (almost two-thirds in 2011) strongly agreed that
type 2 diabetes is increasing rapidly in the United States.

All of these changes represent statistically significant increases since 2006. In addition, the
proportion of respondents who strongly agreed that the number of people with diabetes is
rapidly increasing in the United States increased eight percentage points in 3 years—from 53
percent in 2008 to 61 percent in 2011.
Continued high levels of reported knowledge and awareness suggest that some key diabetes
messages are getting through to their intended audiences.
Perceived risk of diabetes. While diabetes-related knowledge increased from 2006 to 2011, the
NNDS did not find a corresponding increase in individuals’ perceived personal risk of developing
diabetes or prediabetes. In 2006, 2008, and 2011, only about one-fourth of people with risk
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factors said they felt at risk of developing diabetes or prediabetes. The overall proportions were
better among people with prediabetes, with over half (60%–62%) of those surveyed at each
point saying they felt at risk. However, there were no significant gains over time in perceived
risk for people with prediabetes or for people at risk.
Family history. From the 2006 and 2008 NNDS, the NDEP learned that people not diagnosed
with diabetes believed family history was a principal factor that increased their personal risk for
diabetes. The 2008 results also showed a significant increase from 2006 in respondents who
had a history of diabetes in their immediate family. These results prompted the NDEP to revise
its prevention materials, adding family history to the messages to engage its target audiences in
this topic. In 2011, family history was a perceived risk factor reported by about half of
undiagnosed people overall, and was the reason mentioned most often. The proportion of
people not diagnosed with diabetes who thought family history was a major risk factor dropped
10 percentage points from the 2006 level, although the change was not statistically significant.
Among people with prediabetes and Hispanics, there were significant declines in the proportion
citing family history as a reason for their perceived risk.
Comorbidities associated with diabetes. Perceptions of the most serious health problems
caused by diabetes changed significantly from 2006 to 2011 for some problems but not for
others. At all three points in time, blindness and amputation were mentioned most often as the
most serious health problems. Across the time periods, the proportion of people naming
blindness, foot ulcers, or stroke as serious diabetes-related problems significantly decreased,
while those mentioning kidney disease or death significantly increased. There were no
significant changes in awareness with respect to conditions related to heart disease and
diabetes. Cardiovascular disease, high blood pressure/hypertension, and heart attack were
infrequently reported as the most serious health problems associated with diabetes.
Diabetes management. Management and control of their disease for people with diabetes is
modestly better than in 2006, but still shows room for improvement, especially in education for
self-management.
In 2011, even though over three-fourths of people with diabetes (77%) said they checked their
own blood sugar, this was a statistically significant drop from the 90 percent who reported
doing so in 2008.
A modest but significant increase was noted in the understanding of people with diabetes as to
how to use the results of monitoring their own blood sugar. In 2006, 89 percent rated their
understanding as good or excellent, and by 2011, 95 percent did so. There was no significant
change over time in the percentage of people with diabetes who said they had received
instruction on up to nine common diabetes management topics,1 and who rated their
understanding of these topics (other than monitoring their blood sugar) as good or excellent.
Understanding of management of their low blood sugar continued to lag, with no significant
change among people with diabetes surveyed who rated their understanding as poor (12%).
1

Topics included: 1) the role of diet in blood-sugar control, 2) the role of exercise in diabetes care, 3) the
medications the respondent is taking, 4) how to use the results of blood-sugar monitoring, 5) the prevention and
treatment of high blood sugar, 6) the prevention and treatment of low blood sugar, 7) the prevention of long-term
complications of diabetes, 8) proper foot care, and 9) the benefits of improving blood-sugar control.

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Implications for the NDEP
Findings from the NNDS can help identify education, information, and messaging opportunities
for the NDEP. Over the three rounds of the survey, there has been substantial progress in
knowledge and awareness of diabetes, including primary and secondary prevention. This is
good news for the NDEP, and suggests that future program efforts can concentrate on
increasing awareness of personal risk for diabetes and on the behavioral aspects of diabetes
prevention and management.
The findings on perceived risk of diabetes showed that limited progress has been made among
those undiagnosed with the disease (e.g., people at risk of diabetes and people with
prediabetes). Developing a more thorough understanding of factors that influence individuals’
perceptions of personal risk and their willingness to take action to reduce risk may help the
NDEP craft interventions that reduce the burden of diabetes. Family history is one area where
messaging could be reevaluated to more effectively communicate its role as a risk factor for
type 2 diabetes. More emphasis on the family history message may be necessary to ensure that
the risks associated with a family history of the disease are well understood.
Messages to indicate kidney disease as a serious health problem caused by diabetes appear to
have been effective. However, heart-related conditions are not frequently mentioned as some
of the most serious health problems associated with diabetes, suggesting a need for additional
targeted messages related to cardiovascular disease and diabetes.
NNDS data show that there is still a lot of work to do to increase the understanding of people
with diabetes as to how they can better manage their diabetes. In particular, they need help
learning how to manage low blood sugar.
In summary, the NNDS provides insight into what the NDEP might focus on to motivate people
at risk, people with prediabetes, and people with diabetes to take action to prevent diabetes
and improve their management of the disease. In addition, the NNDS provides information on
how to engage people to improve behaviors associated with diabetes prevention and
management.

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