As state health officials strive to make Iowa the nation’s healthiest state, a new study finds more than half of all Americans are either diabetic or pre-diabetic. Dr. ViJay Shivaswamy, an endocrinologist in Omaha-Council Bluffs, says 14-percent of study participants had the disease while another 38-percent were growing dangerously close. What does it mean to be pre-diabetic?

Of the people surveyed who were deemed pre-diabetic, more than a third of them had not been diagnosed. He says people in that pre-diabetic category need to take action so it doesn’t escalate.

Shivaswamy works at the University of Nebraska Medical Center. The study was published in the Journal of the American Medical Association.