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Trends in Prevalence and Control of Diabetes in the United States, 1988–1994 and 1999–2010Trends in Prevalence and Control of Diabetes in the United States

Elizabeth Selvin, PhD, MPH; Christina M. Parrinello, MPH; David B. Sacks, MB, ChB; and Josef Coresh, MD, PhD
[+] Article and Author Information

From the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins University, Baltimore, and National Institutes of Health, Bethesda, Maryland.

Acknowledgment: The authors thank Dr. Alden L. Gross for sharing an annotated Stata code for equipercentile equating.

Grant Support: By the National Institute of Diabetes and Digestive and Kidney Diseases (grant R01 DK089174) to Dr. Selvin. Ms. Parrinello was supported by the National Heart, Lung, and Blood Institute (grant T32 HL007024). Dr. Sacks was supported by the Intramural Program of the National Institutes of Health.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2411.

Reproducible Research Statement: Study protocol, statistical code, and data set: Available from Dr. Selvin (e-mail, lselvin@jhsph.edu).

Requests for Single Reprints: Elizabeth Selvin, PhD, MPH, Associate Professor of Epidemiology & Medicine, Welch Center for Prevention, Epidemiology and Clinical Research and the Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287; e-mail, lselvin@jhsph.edu.

Current Author Addresses: Drs. Selvin, Parrinello, and Coresh: Welch Center for Prevention, Epidemiology and Clinical Research and the Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287.

Dr. Sacks: Clinical Chemistry Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Building 10, Room 2C-306, 10 Center Drive, Bethesda, MD 20892-1508.

Author Contributions: Conception and design: E. Selvin, C.M. Parrinello.

Analysis and interpretation of the data: E. Selvin, C.M. Parrinello, D.B. Sacks.

Drafting of the article: E. Selvin, C.M. Parrinello, D.B. Sacks, J. Coresh.

Critical revision of the article for important intellectual content: E. Selvin, C.M. Parrinello, D.B. Sacks, J. Coresh.

Final approval of the article: E. Selvin, C.M. Parrinello, D.B. Sacks, J. Coresh.

Statistical expertise: E. Selvin, C.M. Parrinello, J. Coresh.

Obtaining of funding: E. Selvin.

Administrative, technical, or logistic support: E. Selvin.


Ann Intern Med. 2014;160(8):517-525. doi:10.7326/M13-2411
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Background: Trends in the prevalence and control of diabetes defined by hemoglobin A1c (HbA1c) levels are important for health care policy and planning.

Objective: To update trends in the prevalence of diabetes, prediabetes, and glycemic control.

Design: Cross-sectional.

Setting: NHANES (National Health and Nutrition Examination Survey) in 1988–1994 and 1999–2010.

Participants: Adults aged 20 years or older.

Measurements: We used calibrated HbA1c levels to define undiagnosed diabetes (≥6.5%); prediabetes (5.7% to 6.4%); and, among persons with diagnosed diabetes, glycemic control (<7.0% or <8.0%). Trends in HbA1c categories were compared with fasting glucose levels (≥7.0 mmol/L [≥126 mg/dL] and 5.6 to 6.9 mmol/L [100 to 125 mg/dL]).

Results: In 2010, approximately 21 million U.S. adults aged 20 years or older had total confirmed diabetes (self-reported diabetes or diagnostic levels for both fasting glucose and calibrated HbA1c). During 2 decades, the prevalence of total confirmed diabetes increased, but the prevalence of undiagnosed diabetes remained fairly stable, reducing the proportion of total diabetes cases that are undiagnosed to 11% in 2005–2010. The prevalence of prediabetes was lower when defined by calibrated HbA1c levels than when defined by fasting glucose levels but has increased from 5.8% in 1988–1994 to 12.4% in 2005–2010 when defined by HbA1c levels. Glycemic control improved overall, but total diabetes prevalence was greater and diabetes was less controlled among non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites.

Limitation: Cross-sectional design.

Conclusion: Over the past 2 decades, the prevalence of total diabetes has increased substantially. However, the proportion of undiagnosed diabetes cases decreased, suggesting improvements in screening and diagnosis. Among the growing number of persons with diagnosed diabetes, glycemic control improved but remains a challenge, particularly among non-Hispanic blacks and Mexican Americans.

Primary Funding Source: National Institutes of Health.

Figures

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Figure 1.

Trends in the prevalence of diagnosed diabetes and undiagnosed diabetes (calibrated hemoglobin A1c levels ≥6.5%), by age and race/ethnic group.

Data from U.S. adults aged ≥20 y in NHANES 1988–1994, 1999–2004, and 2005–2010. NHANES = National Health and Nutrition Examination Survey.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Prevalence of total confirmed diabetes and obesity.

Data from U.S. adults aged ≥20 y in NHANES 1988–1994, 1999–2004, and 2005–2010. Total confirmed diabetes was defined as diagnosed diabetes or undiagnosed diabetes with diagnostic levels of both hemoglobin A1c (≥6.5%) and fasting glucose (7.0 mmol/L [≥126 mg/dL]). Obesity was defined as body mass index ≥30 kg/m2; 601 persons were missing body mass index data. Prevalence estimates for total confirmed diabetes and obesity were obtained using only the subsample of participants who attended the morning fasting session (7385 participants for 1988–1994, 5680 participants for 1999–2004, and 6719 participants for 2005–2010). The midpoint for obesity prevalence between 1988–1994 and 1999–2004 was calculated as the average of the prevalence of the 2 periods. NHANES = National Health and Nutrition Examination Survey.

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