In the JournalsPerspective

Nearly half of US population estimated to have diabetes, prediabetes

Recent data indicate that nearly half of the U.S. adult population has diabetes or prediabetes, with prevalence of diabetes estimated at 12% to 14% and prediabetes estimated at 37% to 38% in 2011 to 2012, according to recent study findings published in JAMA.

“The recent prevalence and trends in diabetes can be estimated using U.S. survey data with information on a previous diabetes diagnosis and measured glucose levels,” the researchers wrote. “Studies have shown that the prevalence of diagnosed diabetes, total diabetes (diagnosed plus undiagnosed) and type 1 diabetes has increased in the U.S. population during the past decades.”

Andy Menke, PhD, of Social & Scientific Systems Inc. in Silver Spring, Maryland, and colleagues conducted cross-sectional surveys from 1988 to 1994 and 1999 to 2012 on nationally representative samples of the civilian, noninstitutionalized U.S. population to determine recent prevalence and U.S. trends in total diabetes, diagnosed diabetes and undiagnosed diabetes. National Health and Nutrition Examination Survey data were evaluated for 2,781 adults from 2011 to 2012 to estimate recent prevalence and 23,634 adults from 1998 to 2010 to estimate trends.

Diabetes prevalence was defined using a previous diagnosis of diabetes or, if there was no diagnosis of diabetes, by HbA1c level of 6.5% or more, fasting plasma glucose level of 126 mg/dL or 2-hour plasma glucose levels of 200 mg/dL or more. HbA1c levels of 5.7% to 6.4%, FPG of 100 mg/dL to 125 mg/dL or 2-hour plasma glucose level of 140 mg/dL to 199 mg/dL was used to define prediabetes.

Researchers found a 14.3% unadjusted prevalence of total diabetes, 9.1% unadjusted prevalence of diagnosed diabetes, 5.2% unadjusted prevalence of undiagnosed diabetes and 38% unadjusted prevalence of prediabetes in the overall 2011-2012 population when using all definitions for diabetes and prediabetes. Thirty-six percent of those with diabetes were undiagnosed.

When using just the HbA1c or FPG definition, the unadjusted prevalence of total diabetes was 12.3%; 25.2% of those with diabetes were undiagnosed.

Black participants (P < .001), Asian participants (P = .007) and Hispanic participants (P < .001) had a higher age-standardized prevalence of diabetes compared with white participants. Asian participants (P = .004) and Hispanic participants (P = .02) had a higher age-standardized prevalence of undiagnosed diabetes compared with all other racial and ethnic groups.

When using the HbA1c or FPG definition, the age-standardized prevalence of diabetes increased from 9.8% in 1988-1994 to 12.4% in 2011-2012 (P < .001 for trend). Prevalence remained steady from 2007-2008 (12.5%) and 2011-2012 (12.4%).

“Between 1988-1994 and 2011-2012, the prevalence of diabetes increased significantly among the overall population and among each age group, both sexes, every racial/ethnic group, every education level and every income level, with a particularly rapid increase among non-Hispanic black and Mexican American participants,” the researchers wrote. “The proportion of people who had undiagnosed diabetes significantly decreased.”

In an accompanying editorial, William H. Herman, MD, MPH, and Amy E. Rothberg, MD, PhD, both of the University of Michigan Health System, wrote that the “data provide a glimmer of hope.”

“The fact that the proportion of individuals with undiagnosed diabetes in the United States is decreasing is encouraging in that reducing the lead time between diabetes onset and clinical diagnosis, combined with prompt initiation of treatment for glycemia and [CV] risk factors, is likely to confer substantial health benefits,” they wrote. “However, the finding that an estimated one-quarter with diabetes in the United States remain undiagnosed is hardly surprising.” – by Amber Cox

Disclosure: Herman reports various financial ties with Lexicon Pharmaceuticals, Merck Sharp & Dohme and the Profil Institute.

Recent data indicate that nearly half of the U.S. adult population has diabetes or prediabetes, with prevalence of diabetes estimated at 12% to 14% and prediabetes estimated at 37% to 38% in 2011 to 2012, according to recent study findings published in JAMA.

“The recent prevalence and trends in diabetes can be estimated using U.S. survey data with information on a previous diabetes diagnosis and measured glucose levels,” the researchers wrote. “Studies have shown that the prevalence of diagnosed diabetes, total diabetes (diagnosed plus undiagnosed) and type 1 diabetes has increased in the U.S. population during the past decades.”

Andy Menke, PhD, of Social & Scientific Systems Inc. in Silver Spring, Maryland, and colleagues conducted cross-sectional surveys from 1988 to 1994 and 1999 to 2012 on nationally representative samples of the civilian, noninstitutionalized U.S. population to determine recent prevalence and U.S. trends in total diabetes, diagnosed diabetes and undiagnosed diabetes. National Health and Nutrition Examination Survey data were evaluated for 2,781 adults from 2011 to 2012 to estimate recent prevalence and 23,634 adults from 1998 to 2010 to estimate trends.

Diabetes prevalence was defined using a previous diagnosis of diabetes or, if there was no diagnosis of diabetes, by HbA1c level of 6.5% or more, fasting plasma glucose level of 126 mg/dL or 2-hour plasma glucose levels of 200 mg/dL or more. HbA1c levels of 5.7% to 6.4%, FPG of 100 mg/dL to 125 mg/dL or 2-hour plasma glucose level of 140 mg/dL to 199 mg/dL was used to define prediabetes.

Researchers found a 14.3% unadjusted prevalence of total diabetes, 9.1% unadjusted prevalence of diagnosed diabetes, 5.2% unadjusted prevalence of undiagnosed diabetes and 38% unadjusted prevalence of prediabetes in the overall 2011-2012 population when using all definitions for diabetes and prediabetes. Thirty-six percent of those with diabetes were undiagnosed.

When using just the HbA1c or FPG definition, the unadjusted prevalence of total diabetes was 12.3%; 25.2% of those with diabetes were undiagnosed.

Black participants (P < .001), Asian participants (P = .007) and Hispanic participants (P < .001) had a higher age-standardized prevalence of diabetes compared with white participants. Asian participants (P = .004) and Hispanic participants (P = .02) had a higher age-standardized prevalence of undiagnosed diabetes compared with all other racial and ethnic groups.

When using the HbA1c or FPG definition, the age-standardized prevalence of diabetes increased from 9.8% in 1988-1994 to 12.4% in 2011-2012 (P < .001 for trend). Prevalence remained steady from 2007-2008 (12.5%) and 2011-2012 (12.4%).

“Between 1988-1994 and 2011-2012, the prevalence of diabetes increased significantly among the overall population and among each age group, both sexes, every racial/ethnic group, every education level and every income level, with a particularly rapid increase among non-Hispanic black and Mexican American participants,” the researchers wrote. “The proportion of people who had undiagnosed diabetes significantly decreased.”

In an accompanying editorial, William H. Herman, MD, MPH, and Amy E. Rothberg, MD, PhD, both of the University of Michigan Health System, wrote that the “data provide a glimmer of hope.”

“The fact that the proportion of individuals with undiagnosed diabetes in the United States is decreasing is encouraging in that reducing the lead time between diabetes onset and clinical diagnosis, combined with prompt initiation of treatment for glycemia and [CV] risk factors, is likely to confer substantial health benefits,” they wrote. “However, the finding that an estimated one-quarter with diabetes in the United States remain undiagnosed is hardly surprising.” – by Amber Cox

Disclosure: Herman reports various financial ties with Lexicon Pharmaceuticals, Merck Sharp & Dohme and the Profil Institute.

    Perspective
    Kevin M. Pantalone

    Kevin M. Pantalone

    While it is encouraging that the increasing prevalence of type 2 diabetes appears to be leveling off, the fact remains that the burden of the disease remains rather high in terms of the overall number of patients with type 2 diabetes. The health care system needs to do a better job, from a population standpoint, of identifying patients with type 2 diabetes earlier on in the disease course, to initiate therapy as early as possible, and to help reduce their risk for developing diabetes-related complications. Studies have estimated that patients have often had type 2 diabetes for 5 years prior to the formal diagnosis, so typically when we do make the diagnosis of type 2 diabetes, we are already lagging behind.  

    The number of patients with prediabetes (ie, those at an increased risk of developing diabetes) is rather staggering. Many of these patients with prediabetes will progress to type 2 diabetes. It appears that intervening at the earliest sign of a problem, whether that be a state of obesity or prediabetes, with treatment and education, would be a better strategy than waiting idly for the patient to progress to type 2 diabetes prior to intervening. Unfortunately, in our current health care system, this occurs far too often.

    • Kevin M. Pantalone, DO, FACE
    • Endocrinologist at the Cleveland Clinic

    Disclosures: Pantalone reports various financial ties with AstraZeneca, Eli Lilly, Merck and Novo Nordisk.