Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012.
Level 4 - case-series / case-control
Repeated cross-sectional national survey data
PubMed 26348752 · doi:10.1001/jama.2015.10029
What was done
Researchers analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) spanning 1988–1994 and 1999–2012 to evaluate prevalence and temporal trends of diabetes and prediabetes in noninstitutionalized US adults. Recent prevalence was estimated using 2,781 adults from 2011–2012, and trends were evaluated using an additional 23,634 adults from 1988–2010. Diabetes was classified by self-reported prior diagnosis or laboratory thresholds: hemoglobin A1c ≥6.5%, fasting plasma glucose (FPG) ≥126 mg/dL, or 2-hour plasma glucose (2-hour PG) ≥200 mg/dL. Prediabetes was defined by A1c 5.7%–6.4%, FPG 100–125 mg/dL, or 2-hour PG 140–199 mg/dL.
What was found
In 2011–2012, unadjusted total diabetes prevalence using the A1c, FPG, or 2-hour PG definition was 14.3% (95% CI, 12.2%–16.8%), comprising 9.1% diagnosed and 5.2% undiagnosed (36.4% of total cases were undiagnosed); prediabetes prevalence was 38.0% (95% CI, 34.7%–41.3%). Using the A1c or FPG definition, total diabetes prevalence was 12.3% (95% CI, 10.8%–14.1%), with 25.2% undiagnosed. Age-standardized total diabetes prevalence was significantly higher among non-Hispanic Black (21.8%), Hispanic (22.6%), and non-Hispanic Asian adults (20.6%) than non-Hispanic White adults (11.3%). Undiagnosed proportions were highest in Asian (50.9%) and Hispanic adults (49.0%). From 1988–1994 to 2011–2012, age-standardized total diabetes (A1c or FPG definition) increased from 9.8% to 12.4% (P < .001 for trend), with statistically significant increases observed across all age, sex, racial/ethnic, education, and income subgroups.
Why it matters
This study provides nationally representative benchmark figures showing that diabetes affects roughly 1 in 7 US adults, with substantial racial and ethnic disparities in total prevalence and unrecognized disease burden.
Limits
The survey excludes institutionalized populations and active-duty military. Laboratory definitions relied on single-occasion testing rather than repeated confirmatory testing used in clinical diagnosis. Diagnosed diabetes status relied on self-report.
Cited by
- supports Approximately 50% of American adults have either prediabetes or type 2 diabetes.