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Editorials |15 April 2014

Diabetes, Prediabetes, and Glycemic Control in the United States: Challenges and Opportunities

Roeland J.W. Middelbeek, MD; Martin J. Abrahamson, MD

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Over the past several decades, U.S. obesity rates have increased dramatically. Today, more than one third of U.S. adults are obese (1). This increase has been attributed to many factors (most notably, dietary changes and lack of physical activity). A concomitant increase in type 2 diabetes parallels the increased incidence of obesity. Type 2 diabetes represents more than 90% of all diabetes cases and is associated with many complications, including neuropathy, retinopathy, nephropathy, and cardiovascular and cerebrovascular disease. The cost of diabetes and its complications was estimated to be $245 billion in 2012, representing approximately 9% of the health care costs in the United States (2).
In this issue, Selvin and colleagues (3) examine the prevalence of diabetes and prediabetes as well as glycemic control in 43 439 adults followed in NHANES (National Health and Nutrition Examination Survey) from 1988 to 1994 and 1999 to 2010, based on calibrated hemoglobin A1c (HbA1c) and fasting plasma glucose levels. Diabetes was either self-reported (previously diagnosed) or defined by a single HbA1c level of 6.5% or greater or a fasting plasma glucose level of 7.0 mmol/L or greater (≥126 mg/dL). During the study, the total prevalence of diabetes (diagnosed and undiagnosed) increased from 5.5% to 9.3%, corresponding to nearly 21 million U.S. adults. Although the prevalence of previously diagnosed diabetes increased, the percentage of persons with undiagnosed diabetes decreased to 11%. Similar increases were seen in the prevalence of prediabetes: Of interest, when defined by HbA1c...
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Middelbeek RJ, Abrahamson MJ. Diabetes, Prediabetes, and Glycemic Control in the United States: Challenges and Opportunities. Ann Intern Med. 2014;160:572–573. doi: 10.7326/M14-0539

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Published: Ann Intern Med. 2014;160(8):572-573.

DOI: 10.7326/M14-0539

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