Trends in Prevalence and Control of Diabetes in the United States, 1988–1994 and 1999–2010

Abstract

Background Trends in the prevalence and control of diabetes defined by hemoglobin A1c (HbA1c) are important for health care policy and planning. Objective To update trends in prevalence of diabetes, pre-diabetes, and glycemic control in persons with diagnosed diabetes over the past two decades in U.S. adults. Design Cross-sectional. Setting The National Health and Nutrition Examination Surveys 1988-1994 and 1999-2010. Participants Adults 20 years or older. Measurements We used calibrated HbA1c to define undiagnosed diabetes (≥6.5%), pre-diabetes (5.7-6.4%), and, among persons with diagnosed diabetes, glycemic control (<7.0% or <8.0%). Trends in HbA1c categories were compared to fasting glucose (≥7.0 and 5.6-6.9 mmol/l [≥126 and 100-125 mg/dL]). Results In 2010, there were ~21 million adults aged 20 years or older with total confirmed diabetes (self-reported diabetes or diagnostic values for both fasting glucose and calibrated HbA1c) in the U.S. The prevalence of total confirmed diabetes increased but the prevalence of undiagnosed diabetes has remained fairly stable, reducing the proportion of total diabetes cases that are undiagnosed to 11% in 2005-10. The prevalence of pre-diabetes was lower when defined by calibrated HbA1c compared to when defined by fasting glucose but has increased from 5.8% in 1988-1994 to 12.4% in 2005-2010 when defined by HbA1c. Glycemic control has improved overall but total diabetes prevalence was higher and diabetes was less controlled among non-Hispanic blacks and Mexican Americans compared to non-Hispanic whites. Limitations Cross-sectional design. Conclusions Over the past two decades, the prevalence of total diabetes has increased substantially. However, the proportion of diabetes cases that are undiagnosed has decreased suggesting improvements in screening and diagnosis. Among the growing number of persons with diagnosed diabetes, glycemic control improved but remains a challenge, particularly among non-Hispanic blacks and Mexican Americans.

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