Elizabeth Selvin, PhD, MPH; Dan Wang, MS; Alexandra K. Lee, PhD, MSPH; Richard M. Bergenstal, MD; Josef Coresh, MD, PhD
Grant Support: Dr. Selvin was supported by National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases grant K24DK106414. Dr. Lee was supported by NIH, National Heart, Lung, and Blood Institute grant T32HL007024.
Disclosures: Dr. Selvin reports grants from the Foundation for the National Institutes of Health and the NIH outside the submitted work. Dr. Bergenstal has been a research investigator or consultant for Abbott Diabetes Care, Becton Dickinson, Boehringer Ingelheim, Bristol-Myers Squibb/AstraZeneca, Calibra, Eli Lilly, Hygieia, Johnson & Johnson, Medtronic, Merck, Novo Nordisk, Roche, Sanofi, Takeda, and Dexcom but has received no personal income from these companies. Dr. Coresh reports grants from the NIH and National Kidney Foundation during the conduct of the study and outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1272.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Selvin (e-mail, email@example.com).
Requests for Single Reprints: Elizabeth Selvin, PhD, MPH, Welch Center for Prevention, Epidemiology and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore MD 21287; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Selvin, Lee, and Coresh and Ms. Wang: Welch Center for Prevention, Epidemiology and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287.
Dr. Bergenstal: International Diabetes Center, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416.
Author Contributions: Conception and design: E. Selvin.
Analysis and interpretation of the data: E. Selvin, D. Wang, A.K. Lee, R.M. Bergenstal.
Drafting of the article: E. Selvin.
Critical revision for important intellectual content: E. Selvin, A.K. Lee, R.M. Berganstal; J. Coresh.
Final approval of the article: E. Selvin, D. Wang, A.K. Lee, R.M. Bergenstal, J. Coresh.
Statistical expertise: E. Selvin.
Obtaining of funding: E. Selvin.
Collection and assembly of data: E. Selvin.
A common belief is that one quarter to one third of all diabetes cases remain undiagnosed. However, such prevalence estimates may be overstated by epidemiologic studies that do not use confirmatory testing, as recommended by clinical diagnostic criteria.
To provide national estimates of undiagnosed diabetes by using a confirmatory testing strategy, in line with clinical practice guidelines.
National Health and Nutrition Examination Survey results from 1988 to 1994 and 1999 to 2014.
U.S. adults aged 20 years and older.
Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose (≥7.0 mmol/L [≥126 mg/dL]) and hemoglobin A1c (≥6.5%) in persons without diagnosed diabetes.
The prevalence of total (diagnosed plus confirmed undiagnosed) diabetes increased from 5.5% (9.7 million adults) in 1988 to 1994 to 10.8% (25.5 million adults) in 2011 to 2014. Confirmed undiagnosed diabetes increased during the past 2 decades (from 0.89% in 1988 to 1994 to 1.2% in 2011 to 2014) but has decreased over time as a proportion of total diabetes cases. In 1988 to 1994, the percentage of total diabetes cases that were undiagnosed was 16.3%; by 2011 to 2014, this estimate had decreased to 10.9%. Undiagnosed diabetes was more common in overweight or obese adults, older adults, racial/ethnic minorities (including Asian Americans), and persons lacking health insurance or access to health care.
Establishing the burden of undiagnosed diabetes is critical to monitoring public health efforts related to screening and diagnosis. When a confirmatory definition is used, undiagnosed diabetes is a relatively small fraction of the total diabetes population; most U.S. adults with diabetes (about 90%) have received a diagnosis of the condition.
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.
Selvin E, Wang D, Lee AK, Bergenstal RM, Coresh J. Identifying Trends in Undiagnosed Diabetes in U.S. Adults by Using a Confirmatory Definition: A Cross-sectional Study. Ann Intern Med. ;167:769–776. doi: 10.7326/M17-1272
Download citation file:
Published: Ann Intern Med. 2017;167(11):769-776.
Published at www.annals.org on 24 October 2017
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
Results provided by:
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use