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CDC: 14% of US adults have diabetes, many unaware of disease status

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September 22, 2018

The prevalence of diabetes among adults in the United States rose to 14% between 2013 and 2016, with nearly 31% of those with diabetes unaware they have the disease, according to a new report from the CDC’s National Center for Health Statistics.

The report, which presents findings from the National Health and Nutrition Examination Survey, a cross-sectional sample of U.S. adults, also notes that the prevalence of total, diagnosed and undiagnosed diabetes was higher among Hispanic vs. white adults, whereas the prevalence of total and diagnosed diabetes was higher among black vs. white adults.

“Type 2 diabetes can progress over an extended time period with gradual, often unnoticed changes occurring before diagnosis,” Nicholas D. Mendola, MPH, a student volunteer with the National Center for Health Statistics (NCHS), and colleagues wrote in the NCHS Data Brief. “If left unmanaged, diabetes may contribute to serious health outcomes, including neuropathy, nephropathy, retinopathy, coronary artery disease, stroke and peripheral vascular disease.”

For the survey, participants were classified as having diagnosed diabetes if they responded “yes” to a question on whether they had the disease at any time other than pregnancy. Undiagnosed diabetes was defined as a fasting plasma glucose measurement of at least 126 mg/dL or an HbA1c of at least 6.5% in an adult who did not report a diagnosis of diabetes by a health care provider. Total diabetes was defined as the combined, overall prevalence of diagnosed and undiagnosed diabetes.

The latest data show that the prevalence of total diabetes was higher among men vs. women (10.8% vs. 8.8%) and increased with age. Prevalence of total diabetes ranged from 3.5% among adults aged 20 to 39 years to 28.2% among adults aged at least 60 years. Additionally, total diabetes prevalence was higher among all minority groups; prevalence was highest among Hispanic adults (19.8%), followed by black adults (17.9%) and Asian adults (15.3%) vs. white adults (12.4%)

Researchers also found that total diabetes prevalence increased with increasing weight status category, from 6.2% among adults with underweight or normal weight, to 11.8% among adults with overweight to 20.7% among adults with obesity. Similarly, the prevalence of undiagnosed diabetes increased with increasing weight category, from 3.2% among adults with overweight to 6.8% among adults with obesity.

The NHANES consists of interviews conducted in participants’ homes, standardized exams in mobile centers and laboratory blood tests. Criteria from the American Diabetes Association were used to define diabetes. For the 2013-2016 survey, Hispanic, black and Asian adults were oversampled to obtain reliable estimates, according to researchers.

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“Continued monitoring of total, diagnosed and undiagnosed diabetes will provide information about the burden of diabetes among adults in the United States,” the researchers wrote. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

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These numbers are higher than previously announced numbers, across all categories, which is frightening. Traditional risk factors for developing diabetes in adults are obesity, positive family history of the disease, the presence of multiple components of metabolic syndrome and a history of gestational diabetes, as well as a sedentary lifestyle. Research also suggests that the intrauterine environment may also play a role in diabetes risk.

A person with obesity and a strong family history should know they are at high risk for the disease and should be screened for diabetes. If a person’s fasting glucose level is normal, I would further recommend a 2-hour postprandial glucose measurement. Adults with impaired glucose tolerance have a higher risk for diabetes. If a clinician intervenes, that person has a good chance of reversing their IGT status, whereas emerging evidence suggests that impaired fasting glucose, or IFG, may not be able to be reversed, likely because there are different mechanisms involved.

When you see the prevalence of diabetes increasing at this rate, while obesity is tending to level off, you have to ask, what is going on? We really need to understand these disease mechanisms more.

There must be a concerted effort to recognize diabetes as the health crisis that it is. It is important to get the word out to the public about the risk factors for diabetes, as well as the related risk for other conditions related to the disease, as well as the cost impact on the health care system overall. Communities and health care providers must join together to get that message out.

 

Willa Hsueh, MD

Director, Diabetes and Metabolism Research Center
Professor, Endocrinology, Diabetes and Metabolism
The Ohio State University Wexner Medical Center

Disclosure: Hsueh reports she serves on advisory boards for Novo Nordisk and Merck and receives funding from the NIH.