National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

Abstract

BACKGROUND: There are few current population-based estimates of the patterns of diabetes screening in the United States. The American Diabetes Association (ADA) recommends universal screening of adults ≥ 45 years, and high-risk adults < 45 years, but there is no current assessment of ADA guideline performance in detecting diabetes and prediabetes. Furthermore, data on racial/ ethnic patterns of screening are limited. OBJECTIVE: Our aim was to estimate diabetes screening prevalence for the US adult population and specifically for those who meet ADA criteria; to report the prevalence of prediabetes and diabetes among these groups; and to determine if high-risk race/ethnicity was associated with reported screening. DESIGN: This was a Cross-sectional survey. PARTICIPANTS: Non-pregnant adults (≥ 21 years) without diabetes or prediabetes who participated in the National Health and Nutrition Examination Survey (NHANES) in 2005-2012 (n=17,572) were included in the study. "Screening-recommended" participants, classified by ADA criteria, included (1) adults ≥ 45 years and (2) "high-risk" adults < 45 years. "Screening-not-recommended" participants were adults < 45 years who did not meet criteria. MAIN MEASURES: Diabetes screening status was obtained by self-report. We used calibrated HbA 1c and/or fasting glucose levels to define undiagnosed diabetes and prediabetes. KEY RESULTS: Seventy-six percent of the study population (approximately 136 million US adults) met ADA criteria. Among them, less than half (46.2 %) reported screening; undiagnosed diabetes affected 3.7 % (5 million individuals), and undiagnosed prediabetes affected 36.3 % (49 million people.) African Americans were more likely to report screening, both among adults ≥ 45 years and among "high risk" younger adults (OR 1.27 and 1.36, respectively.) Hispanic participants were also more likely to report screening (OR 1.31 for older adults, 1.42 for younger adults.) The screening rate among "screeningnot-recommended" adults was 29.6 %; the prevalence of diabetes and prediabetes were 0.4 and 10.2 %, respectively. CONCLUSIONS:In a nationally representative sample, 76 % of adults met ADA screening criteria, of whom fewer than half reported screening. Limitations include crosssectional design and screening self-report.

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

“…National estimates suggest that 46% of adults are appropriately screened for diabetes. 4 Of these, 30% have prediabetes 5 with only 7% to 11% aware of their condition. 5,6 People with prediabetes can substantially reduce their risk of progression to type 2 diabetes through participation in evidence-based lifestyle change programs.…”

Factors associated with undiagnosed diabetes among adults with diabetes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

“…We found that a family history of diabetes was associated with lower odds of being undiagnosed, which was also observed in NHANES (15). Screening guidelines take into account a family history of diabetes (2) and people with a family history are more likely to be screened (4). In addition, we found that health insurance modified this association such that those with a family history of diabetes and no health insurance were more likely to be undiagnosed compared to those with insurance.…”

“…There are effective treatments for diabetes that reduce the risk of complications, but patients who are never diagnosed cannot utilize these treatments (2, 3). Screening is not routine for all asymptomatic people in the general population, and even among people who meet screening criteria for diabetes by the American Diabetes Associatio n (ADA), less than half reported diabetes screening in the previous three years (4). As a result, many people with diabetes are undiagnosed.…”

Diabetes risk scores for Hispanics living in the United States: A systematic review

“…Universal screening is recommended for high-risk adults but there is limited information on the implementation or effectiveness of national recommendations to identify those with diabetes [12]. Only half of those individuals meeting American Diabetes Association’s (ADA) screening recommendation criteria report being screened, while the screening rate for those not meeting these criteria is 30% [13]. Actual diagnostic testing involving laboratory measures is less prevalent in racial/ethnic minorities, those with lower socioeconomic status, and those who lack health insurance [14].…”