​Susan H. Babey is co-director of the Center's chronic disease program and lead author of a policy brief about high rate of prediabetes and undiagnosed diabetes among adult Californians. In this brief interview, Babey discusses why people are unaware they have prediabetes, how they can avoid prediabetes and type 2 diabetes, and how the lack of choice plays a role in health.

Q: Your study reports people are unaware they have prediabetes ― why is that? Should people use those $15 mail-in blood glucose test kits to find out?

​​The Centers for Disease Control and Prevention estimates that 90 percent of those with prediabetes do not know they have it. Prediabetes has no symptoms. The only way to know if you have prediabetes is with a blood glucose test. But not everyone should ask for a blood glucose test.

The risk factors for prediabetes include age, especially after 45 years of age; obesity; a family history of diabetes; a history of diabetes while pregnant (gestational diabetes); and a lack of physical activity.

The American Diabetes Association has an online quiz people can take to see their risk score for prediabetes, which may be a place to start. If you’re concerned, or if you have a number of the risk factors, you should discuss with your health care provider whether a blood glucose test would be appropriate.

Q: Is there anything specific a person can do to avoid prediabetes or reduce the risk of type 2 diabetes if they already have prediabetes?

​There is very good evidence that for those with prediabetes, losing weight by increasing physical activity and improving diet can cut the risk of developing type 2 diabetes in half. According to the CDC, losing 5 percent to 7 percent of your body weight (10 to 14 pounds for a 200-pound person) and getting at least 150 minutes each week of physical activity, such as brisk walking, can help you prevent or delay type 2 diabetes.

Referral to and participation in a Diabetes Prevention Program recognized as effective by the CDC can help people make these changes and prevent type 2 diabetes. Check here for other information on prediabetes prevention.

Q: In your policy brief, you recommend promoting communities and environments that encourage physical activity and healthy eating. Aren't what you eat and how much you exercise up to you?

​We do make choices about what to eat and whether to do something active or sit on the couch, but choices are made within a context and that context has a lot of influence on the choices available to us. Lack of physical activity and unhealthy eating often result from a lack of opportunity to make better choices.

For example, living in neighborhoods where people feel unsafe or don't have access to safe parks limits their ability to exercise outdoors. If people live in areas where fresh fruits and vegetables are less available or affordable, people can't eat the recommended amount.

Having transportation constraints prevent people from getting to better-stocked grocery stores where there are healthier options, so they eat the less healthy foods available in their neighborhoods. People can't afford to live near where they work so they must spend a lot of time commuting between home and work.

If we can improve neighborhoods so that they support physical activity and healthy eating, then those healthy choices should be easier to make.