According to the Health Belief Model, adults with prediabetes (pDM) who perceive higher personal risk for developing diabetes (DM) may be more enthusiastic about engaging in the Diabetes Prevention Program (DPP) than those who perceive lower personal risk. Between 2015 and 2019, the University of Michigan, a self-insured employer, offered to cover the DPP at no out-of-pocket cost for individuals with pDM among all its employees, dependents, and retirees. We surveyed 720 people with pDM who engaged in the DPP and a random sample of 2379 people with pDM who did not engage in the DPP. Perception of risk for developing DM was assessed using the item: “What do you think your risk is for getting diabetes over the next 5 years?”, and defined as a continuous variable (1-“almost no chance” to 4-“high chance”). Engagement in the DPP was defined as a dichotomous variable (yes-no). Linear regression was used to test associations between perceived risk for developing DM and engagement in the DPP. A cohort of 533 people who engaged in the DPP and 1023 people who did not engage in the DPP responded to the survey, response rates of 74% and 43%, respectively. Among the people with data on perceived DM risk (N=1547), the mean age was 55±11 years, 62% were women, 73% were non-Hispanic white, 64% had a level of education of 4-year college graduate or more, 60% had a family income ≥$75,000/year, the mean BMI was 31±7 kg/m2, 48% were aware of their pDM, 51% had a family history of DM, and 9% of the women had a history of gestational diabetes (GDM). In bivariate analyses, perceived personal DM risk differed by age, sex, education, BMI, awareness of pDM, family history of DM, and history of GDM (women only) (all at P<0.05). People who engaged in the DPP had a higher mean risk perception 2.52±0.04 vs. 2.40±0.03 (P=0.0044) than those who did not engage in the DPP. These findings suggest that for adults with pDM, perceived personal risk for developing DM may motivate engagement in risk-reducing programs such as the DPP.


K. Joiner: None. L.N. McEwen: None. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp.


National Institutes of Health (R01DK109995)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at