All ETDs from UAB

Advisory Committee Chair

Shannon A Morrison

Advisory Committee Members

Andres Azuero

Amy Goss

Jacqueline Moss

Greg Pavela

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


Prediabetes is a modifiable risk factor for type 2 diabetes (T2D) that effects 88- million U.S. adults. Added sugar is linked to the risk for prediabetes through direct and indirect mechanisms that promote hepatic and whole-body insulin resistance. Added sugar is overconsumed and totals ~13% of American’s daily caloric intake, with consumption highest for non-Hispanic Blacks and Hispanic minority populations also disproportionality affected by prediabetes and T2D. The effects of total added sugar on prediabetes have been mixed; however, total added sugar intake has primarily been examined using added sugar proxies (e.g., sugar-sweetened beverages, fructose), likely increasing systemic measurement error and limiting findings. Thus, it remains unclear if total added sugar consumption increases the risk for prediabetes in U.S. adults and/or if the prediabetes disparities observed in non-Hispanic Blacks and Hispanics are due to greater added sugar consumption, or if total added sugar imparts unique negative metabolic consequences in these groups. Therefore, the purpose of this dissertation was to examine associations between total added sugar consumption and prediabetes using a nationally representative U.S. adult sample (≥20 years) from the 2013-2018 National Health and Nutrition Examination Survey. This purpose was accomplished through the development of three manuscripts: 1) a principle-based concept analysis that evaluated the concept of added sugar in the context of T2D risk (i.e., prediabetes); 2) a cross-sectional, correlational study that examined the associations between prediabetes awareness and total added sugar consumption; and 3) a cross-sectional, correlational study that examined the associations between total added sugar consumption and risk for prediabetes.This research will advance nursing and health science through the examination of added sugar’s association with prediabetes in U.S. adults. Manuscript one revealed that added sugar is an immature concept warranting further investigation. Manuscript two revealed that prediabetes awareness was not associated with reduced consumption of added sugar. Manuscript three revealed that total and percent intakes of added sugar do not increase the risk of prediabetes, even for different racial/ethnic groups. More research from prospective cohort and experimental studies are needed to confirm these findings.

Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.