Background/Purpose:   In the US, over 86 million adults have pre-diabetes; physical activity is recommended to reduce the high risk of developing diabetes.  Arthritis is a common comorbid condition among persons with diabetes that is associated with reduced physical activity, presumably because of joint pain and swelling.  Arthritis may have the same effect among adults with pre-diabetes, but population-based estimates of arthritis prevalence among adults with pre-diabetes are unknown.

Methods: We used the 2009-2014 National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of arthritis among adults with pre-diabetes, overall and by various sociodemographic characteristics, as well as those with diabetes or neither condition.  NHANES is a nationally representative sample of the US non-institutionalized adult population with both interview and examination components. We limited our sample to adults aged ≥20 years with a fasting plasma glucose (fpg) measurement; unweighted sample sizes were 2,787 in 2009-2010; 2,471 in 2011-2012, and 2,574 in 2013-2014. Pre-diabetes was defined as glycated hemoglobin A1c (HbA1c) level of 5.7% to <6.5%, or a fasting plasma glucose (fpg) level of 100-125 mg/dL. Diabetes was defined as an HbA1c level of ≥ 6.5%, or fpg level of ≥ 126 mg/dL or a “yes” response to the questions “other than during pregnancy has a doctor or other health professional ever told you that have diabetes or sugar diabetes?” Arthritis was defined as a "yes" response to the questions "Has a doctor or other health professional ever told you that have arthritis?" For comparisons, estimates were age-standardized to the projected 2000 U.S. population; and pairwise comparisons were evaluated using a t-test with a Bonferroni-Holm correction for multiple comparisons.

Results: During 2009-2014, the prevalence (number) of adults with arthritis among those with pre-diabetes was 30% (27.9 million). The age-standardized prevalence of arthritis among adults with pre-diabetes (25.5%; 95% CI: 23.5-27.7%) was significantly (p-value=0.022) higher when compared with adults without diabetes (21.6%; 95% CI: 19.2-24.3%), but similar (p-value=0.182) to those with diabetes (28.6%; 95% CI: 24.8-32.7%)  (Figure). Among adults with pre-diabetes, older adults (age ≥ 65 years), women, and those with <college degree had the highest age-standardized prevalence of arthritis.   

Conclusion: Nearly 28 million adults in the US have pre-diabetes and arthritis, which may impact the physical activity recommended to prevent diabetes. Health care and public health professionals can address arthritis-specific barriers to physically activity among adults with pre-diabetes by promoting evidence-based physical activity, including programs such as EnhanceFitness and Walk with Ease, that reduce joint pain, which in turn may increase physical activity and reduce progression to diabetes.