OBJECTIVE -The purpose of this study was to examine the prevalences of diagnosed and undiagnosed diabetes, and impaired fasting glucose (IFG) in U.S. adults during 1999 -2002, and compare prevalences to those in 1988 -1994. RESEARCH DESIGN AND METHODS -The National Health and Nutrition Examination Survey (NHANES) contains a probability sample of adults aged Ն20 years. In the NHANES 1999NHANES -2002,761 adults were classified on glycemic status using standard criteria, based on an interview for diagnosed diabetes and fasting plasma glucose measured in a subsample.RESULTS -The crude prevalence of total diabetes in 1999 -2002 was 9.3% (19.3 million, 2002 U.S. population), consisting of 6.5% diagnosed and 2.8% undiagnosed. An additional 26.0% had IFG, totaling 35.3% (73.3 million) with either diabetes or IFG. The prevalence of total diabetes rose with age, reaching 21.6% for those aged Ն65 years. The prevalence of diagnosed diabetes was twice as high in non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites (both P Ͻ 0.00001), whereas the prevalence of undiagnosed diabetes was similar by race/ethnicity, adjusted for age and sex. The prevalence of diagnosed diabetes was similar by sex, but prevalences of undiagnosed diabetes and IFG were significantly higher in men. The crude prevalence of diagnosed diabetes rose significantly from 5.1% in 1988 -1994 to 6.5% in 1999 -2002, but the crude prevalences were stable for undiagnosed diabetes (from 2.7 to 2.8%) and IFG (from 24.7 to 26.0%). Results were similar after adjustment for age and sex.CONCLUSIONS -Although the prevalence of diagnosed diabetes has increased significantly over the last decade, the prevalences of undiagnosed diabetes and IFG have remained relatively stable. Minority groups remain disproportionately affected. Diabetes Care 29:1263-1268, 2006D iabetes and its complications are major causes of morbidity and mortality in the U.S. (1). The economic cost of diabetes in medical expenditures and lost productivity was estimated to be $132 billion in the U.S. in 2002 (2). Nationally the prevalence of self-reported diagnosed diabetes has steadily increased over time (3), but the extent to which this increase is due to enhanced detection is uncertain. Undiagnosed diabetes and impaired fasting glucose (IFG) also have important health consequences (4,5). Only one nationally representative survey, The National Health and Nutrition Examination Survey (NHANES), examines both diagnosed diabetes and undiagnosed diabetes. This survey showed that from 1988 to 1994, undiagnosed diabetes comprised approximately one-third of total diabetes (diagnosed and undiagnosed) in U.S. adults (6). The prevalence of IFG was nearly as high as the prevalence of total diabetes. In 1999, the NHANES became a continuous annual survey with data released every 2 years, and we reported the prevalence of diagnosed diabetes, undiagnosed diabetes, and IFG in adults based on data from 1999 to 2000 (7). The limited sample size in these 2 years, however, restricted the detail a...

OBJECTIVE -We examined the prevalences of diagnosed diabetes, and undiagnosed diabetes and pre-diabetes using fasting and 2-h oral glucose tolerance test values, in the U.S. during [2005][2006]. We then compared the prevalences of these conditions with those in 1988 -1994. , the National Health and Nutrition Examination Survey included a probability sample of 7,267 people aged Ն12 years. Participants were classified according to glycemic status by interview for diagnosed diabetes and by fasting and 2-h glucoses measured in subsamples. , the crude prevalence of total diabetes in people aged Ն20 years was 12.9%, of which ϳ40% was undiagnosed. In people aged Ն20 years, the crude prevalence of impaired fasting glucose was 25.7% and of impaired glucose tolerance was 13.8%, with almost 30% having either. Over 40% of individuals had diabetes or pre-diabetes. Almost one-third of the elderly had diabetes, and three-quarters had diabetes or pre-diabetes. Compared with nonHispanic whites, age-and sex-standardized prevalence of diagnosed diabetes was approximately twice as high in non-Hispanic blacks (P Ͻ 0.0001) and Mexican Americans (P ϭ 0.0001), whereas undiagnosed diabetes was not higher. Crude prevalence of diagnosed diabetes in people aged Ն20 years rose from 5.1% in 1988 -1994 to 7.7% in 2005-2006 (P ϭ 0.0001); this was significant after accounting for differences in age and sex, particularly in non-Hispanic blacks. Prevalences of undiagnosed diabetes and pre-diabetes were generally stable, although the proportion of total diabetes that was undiagnosed decreased in Mexican Americans. RESEARCH DESIGN AND METHODS RESULTSCONCLUSIONS -Over 40% of people aged Ն20 years have hyperglycemic conditions, and prevalence is higher in minorities. Diagnosed diabetes has increased over time, but other conditions have been relatively stable.

OBJECTIVETo determine the prevalence of people with diabetes who meet hemoglobin A1c (A1C), blood pressure (BP), and LDL cholesterol (ABC) recommendations and their current statin use, factors associated with goal achievement, and changes in the proportion achieving goals between 1988 and 2010.RESEARCH DESIGN AND METHODSData were cross-sectional from the National Health and Nutrition Examination Surveys (NHANES) from 1988–1994, 1999–2002, 2003–2006, and 2007–2010. Participants were 4,926 adults aged ≥20 years who self-reported a previous diagnosis of diabetes and completed the household interview and physical examination (n = 1,558 for valid LDL levels). Main outcome measures were A1C, BP, and LDL cholesterol, in accordance with the American Diabetes Association recommendations, and current use of statins.RESULTSIn 2007–2010, 52.5% of people with diabetes achieved A1C <7.0% (<53 mmol/mol), 51.1% achieved BP <130/80 mmHg, 56.2% achieved LDL <100 mg/dL, and 18.8% achieved all three ABCs. These levels of control were significant improvements from 1988 to 1994 (all P < 0.05). Statin use significantly increased between 1988–1994 (4.2%) and 2007–2010 (51.4%, P < 0.01). Compared with non-Hispanic whites, Mexican Americans were less likely to meet A1C and LDL goals (P < 0.03), and non-Hispanic blacks were less likely to meet BP and LDL goals (P < 0.02). Compared with non-Hispanic blacks, Mexican Americans were less likely to meet A1C goals (P < 0.01). Younger individuals were less likely to meet A1C and LDL goals.CONCLUSIONSDespite significant improvement during the past decade, achieving the ABC goals remains suboptimal among adults with diabetes, particularly in some minority groups. Substantial opportunity exists to further improve diabetes control and, thus, to reduce diabetes-related morbidity and mortality.

OBJECTIVEWe examined prevalences of previously diagnosed diabetes and undiagnosed diabetes and high risk for diabetes using recently suggested A1C criteria in the U.S. during 2003–2006. We compared these prevalences to those in earlier surveys and those using glucose criteria.RESEARCH DESIGN AND METHODSIn 2003–2006, the National Health and Nutrition Examination Survey included a probability sample of 14,611 individuals aged ≥12 years. Participants were classified on glycemic status by interview for diagnosed diabetes and by A1C, fasting, and 2-h glucose challenge values measured in subsamples.RESULTSUsing A1C criteria, the crude prevalence of total diabetes in adults aged ≥20 years was 9.6% (20.4 million), of which 19.0% was undiagnosed (7.8% diagnosed, 1.8% undiagnosed using A1C ≥6.5%). Another 3.5% of adults (7.4 million) were at high risk for diabetes (A1C 6.0 to <6.5%). Prevalences were disproportionately high in the elderly. Age-/sex-standardized prevalence was more than two times higher in non-Hispanic blacks and Mexican Americans versus non-Hispanic whites for diagnosed, undiagnosed, and total diabetes (P < 0.003); standardized prevalence at high risk for diabetes was more than two times higher in non-Hispanic blacks versus non-Hispanic whites and Mexican Americans (P < 0.00001). Since 1988–1994, diagnosed diabetes generally increased, while the percent of diabetes that was undiagnosed and the percent at high risk of diabetes generally decreased. Using A1C criteria, prevalences of undiagnosed diabetes and high risk of diabetes were one-third that and one-tenth that, respectively, using glucose criteria.CONCLUSIONSAlthough A1C detects much lower prevalences than glucose criteria, hyperglycemic conditions remain high in the U.S., and elderly and minority groups are disproportionately affected.

The higher prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in US blacks as compared with whites may be due to a higher frequency of NIDDM risk factors in blacks, a higher inherent susceptibility to NIDDM among blacks, or the risk factors' having a greater effect in blacks. The authors evaluated 4,379 subjects from the Second National Health and Nutrition Examination Survey (1976-1980) for whom NIDDM was ascertained by medical history and oral glucose tolerance test, and for whom data on a number of risk factors were available. The prevalence of NIDDM was 60% higher in blacks than in whites (p < 0.001) and was highest in black women. Although most risk factors for NIDDM were more common in blacks, this higher frequency did not completely explain the racial disparity in the prevalence of NIDDM. After adjustment for all risk factors by logistic regression, an elevated risk of NIDDM was particularly evident at higher obesity levels in blacks as compared with whites; the odds were 70% higher for blacks at a percentage of desirable weight of 150 (95% confidence interval 1.1-2.8). The risk of NIDDM associated with obesity was greatest in black women: The odds in this group were sevenfold higher at a percentage of desirable weight of 150 versus 100 (95% confidence interval 2.6-18.8). The possibility of racial differences in metabolic adaptation to obesity highlights the importance of preventing this condition in blacks, particularly in black women.

Centers for Disease Control and Prevention and National Institutes of Diabetes and Digestive and Kidney Diseases.

Purpose Although mean concentrations of hemoglobin A1c (A1C), fasting plasma glucose, and 2-hour plasma glucose differ by demographics, it is unclear what other characteristics of the distributions may differ, such as the amount of asymmetry of the distribution (skewness) and shift left or right compared to another distribution (shift). Methods Using kernel density estimation, we created smoothed plots of the distributions of fasting plasma glucose (N=7,250), 2-hour plasma glucose (N=5,851), and A1C (N=16,209) by age, race-ethnicity, and sex in the 2005–2010 National Health and Nutrition Examination Survey, a nationally representative sample of US adults including people with and without diabetes. We tested differences in distributions using cumulative logistic regression. Results The distributions were generally unimodal and right-skewed. All distributions were shifted higher and more right-skewed for older age groups (p<0.001 for each marker). Compared to non-Hispanic whites, the distribution of fasting plasma glucose was shifted higher for Mexican-Americans (p=0.01) while the distribution of A1C was shifted higher for non-Hispanic blacks (p<0.001). The distribution of fasting plasma glucose was shifted higher for men (p<0.001) and the distribution of 2-hour plasma glucose was shifted higher for women (p=0.01). Conclusions We provide a graphic reference for comparing these distributions and diabetes cutpoints by demographic factors.

Survival after ESRD onset is longer in blacks than in whites treated with dialysis, even after adjusting for comorbidity and other factors that affect survival. Survival does not differ by race among transplant patients.