In all, 3867, 5419 and 5683 type 2 diabetes, HR and LR respondents, respectively, completed the baseline questions on health knowledge, attitudes and behaviours. The majority of respondents were women and white. Type 2 diabetes respondents were more likely to have a lower household income and less education than HR or LR respondents, p < 0.01 ().
Characteristics of SHIELD type 2 diabetes mellitus, high-risk and low-risk respondents
Attitudes about diabetes
Approximately 22% of type 2 diabetes respondents agreed (somewhat or strongly) that type 2 diabetes is not as serious as type 1 diabetes compared with 11.2% of HR and 10.8% of LR respondents (p < 0.05, ). About 10% of respondents with or without diabetes agreed that diabetes is only a sugar disease. Most respondents in each group (> 85%) agreed that obesity can aggravate or contribute to the onset of chronic diseases.
Knowledge, attitudes and behaviours for type 2 diabetes, high-risk and low-risk respondents in the SHIELD survey*
Attitudes about health
Most respondents reported that their health had remained about the same compared with 12 months ago; however, significantly fewer type 2 diabetes respondents (48%) than HR (53%) and LR (65%) respondents reported this, p < 0.0001 (). Similarly, the majority of respondents stated that they expect their health to be about the same next year. Yet, significantly more respondents in the type 2 diabetes and HR groups reported that their health would be worse next year than now compared with the LR group (13.5% and 12.2%, respectively, vs. 5.8%, p < 0.05).
Exercise: knowledge and behaviour
More type 2 diabetes (62%) and HR (56%) respondents reported receiving a recommendation by a healthcare professional to increase the amount they exercise, compared with LR respondents (28%) (p < 0.05, ). However, actual behaviour towards exercise showed the opposite pattern. Type 2 diabetes and HR respondents were the least likely to report exercising regularly for at least the past 6 months (26.4% and 26.8% respectively), compared with LR respondents (37.1%, p < 0.0001 for both). Moreover, fewer type 2 diabetes (12.7%) and HR (14.9%) respondents reported doing moderate or vigorous physical activities in the past 7 days than LR respondents (24.1%, p < 0.05) ().
Diet: knowledge and behaviour
More type 2 diabetes respondents (56.3%) than HR (46.9%) or LR (18.4%) respondents reported that in the past 12 months, a healthcare professional recommended that they change what they eat or reduce the amount they eat (p < 0.05, ). A majority of type 2 diabetes respondents reported healthy behaviours regarding diet: 78% reported trying to make healthy food choices most of the time or always. Fewer HR and LR respondents reported these healthy diet behaviours compared with type 2 diabetes respondents (p < 0.05); 70.1% and 68.3%, respectively, reported trying to make healthy food choices (). Only 32.6% of type 2 diabetes, 13.5% of HR and 7.1% of LR groups reported following an eating plan most of the time or always that was prescribed by a physician, p < 0.05.
Weight loss behaviour
More respondents in the type 2 diabetes (69.6%) and HR groups (71.5%) reported trying to lose weight in the past 12 months, compared with respondents in the LR group (54.7%) (p < 0.0001, ). Likewise, 74.9% of type 2 diabetes and 74.0% of HR respondents were trying to keep from gaining weight, compared with 61.7% of LR respondents, p < 0.0001 (). Most respondents in each group who had not been able to maintain their desired weight indicated that it was because of what they ate, whereas approximately one-quarter attributed it to a hormone or metabolism problem.
Among respondents who had at least one visit to a healthcare provider (i.e. primary care physician, nurse practitioner, case manager, health educator, nutritionist/dietician, physical therapist, endocrinologist, cardiologist, pulmonologist, psychiatrist/psychologist, OB/GYN or other specialist) during the previous 12 months, the mean total number of healthcare visits was highest for respondents with type 2 diabetes (11.0), followed by those in the HR (9.4) and LR groups (6.1) (p < 0.05). Respondents in all groups had more visits to providers for rehabilitation and physical therapy than for any other type of provider (). The providers with the least number of visits were diabetes educators, nutritionists and dieticians with 4–5 visits in the past 12 months for each group (). Type 2 diabetes respondents had an average of six visits to primary care providers and six visits to specialists in the past 12 months, compared with 5.2 and 4.1 primary care visits and 5.6 and 5.0 specialists visits for HR and LR, respectively, p < 0.001 for HR vs. type 2 and p < 0.0001 for LR vs. type 2.
Mean number of provider visits for type 2 diabetes, high-risk and low-risk groups
Subgroup analysis: linking attitude to behaviour in type 2 diabetes
The association between type 2 diabetes respondents’ attitudes about weight loss and obesity and actual exercise and diet behaviour was assessed by stratifying their responses (agree vs. disagreed/neutral) to two survey items: ‘obesity aggravates or contributes to the onset of chronic diseases’ and ‘the inability to keep weight off is due to a hormone or metabolism problem’.
Respondents with type 2 diabetes indicated that they understood the impact of obesity on health with 87.1% responding that they agree that obesity aggravates or contributes to the onset of chronic conditions. Those who agreed also reported better exercise and eating habits, than those who disagreed, p < 0.05 (). More respondents who agreed also reported trying to lose weight (70.5%) or keep from gaining weight (76.3%) in the previous 12 months than those who disagreed (64.6% and 66.3%, respectively, p < 0.05). However, when asked about ability to maintain weight, a similar percentage of type 2 diabetes respondents who agreed or disagreed had not maintained their desired weight for a period of 6 months or longer (agree, 66.3%; disagree, 66.7%, p = 0.88) and a similar percentage of respondents agreeing or disagreeing ascribed the inability to maintain desired weight to what they eat or their level of exercise.
Relationship between obesity knowledge and diet and exercise behaviours among type 2 diabetes respondents
For type 2 diabetes respondents, responses to the survey item: ‘the inability to keep weight off is due to a hormone or metabolism problem’ were assessed to determine if the perception of an external, uncontrollable force is associated with diet and exercise behaviour (). Only 38.0% of those with type 2 diabetes disagreed with this statement, whereas 62.0% either agreed or were neutral, indicating that most respondents’ attitude was to associate weight problems with physiological conditions.
A greater percentage of patients who agreed that their inability to lose weight was due to a metabolic or hormone problem reported trying to lose weight (76.4%) or keep from gaining it (78.8%) than those who disagreed (67.2% and 73.7% respectively), p < 0.05 (). In addition, more type 2 diabetes respondents who agreed had been able to maintain a desired weight for a period of 6 months or longer (73.1%), compared with those who disagreed (64.0%), p < 0.05. Approximately half of the respondents who agreed to the statement and who had not been able to maintain a desired weight believed that this was due to an undiagnosed hormone or metabolism problem.