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New Data to Analyze Trends in Diabetes

In 2012, diabetes resulted in the increased use of resources and loss of productivity costing the United States approximately $245 billion. To measure recent incidence and trends in diabetes, available data using surveys were utilized. These U.S. surveys include data about previous diabetes diagnosis and measured glucose levels. Previous studies have shown that in the past decades, total diabetes (diagnosed and undiagnosed) as well as type 1 diabetes has increased. Specifically, diagnosed diabetes increased from 3.5%% to 7.9% from 1990 to 2008 respectively. Thereafter, trends plateaued between 2008 and 2012.

A cross-sectional survey was conducted between 1988-1994 and 1999-2012 utilizing National Health and Nutrition Examination Survey (NHANES) data. Nationally representative samples were used from the U.S. population. A sample of 2,781 adults from 2011-2012 was used to predict recent prevalence, and 23,634 adults from 1988-2010 were used to predict trends. Prevalence was defined using a previous diagnosis of diabetes. If it was not diagnosed, a series of parameters were used such as HbA1C of 6.5% or higher, or fasting glucose of 126 mg/dL or higher, or 2-hour postprandial of 200 mg/dL or higher. Prediabetes was defined as HbA1C of 5.7% to 6.4%, or a fasting glucose of 100-125 mg/dL, or 2-hour postprandial of 140-199 mg/dL.

Depending on which parameters were used, it is predicted that prevalence of diabetes in the U.S. between 2011 and 2012 was 12-14%. Researchers identified a greater prevalence in non-Hispanic blacks, non-Hispanic Asians, and the Hispanic population. Nonetheless, researchers found the new data to be consistent with previous findings. The study between 1988-1994 and 2011-2012 suggests that prevalence of diabetes increased considerably among each age group, males and females, each race group, and regardless of education or income level. The study noted that prevalence in subjects with undiagnosed diabetes was reduced significantly. However, this phenomenon may have been the result of a combination of factors such as improved screening methods and better survival among people who have been diagnosed.

The authors conclude that the estimated prevalence of diabetes in 2011-2012 was 12% to 14% among US adults, and a greater prevalence was observed among subjects that were identified as non-Hispanic black, non-Hispanic Asian, and Hispanic. Prevalence of prediabetes was found to be between 37-38%. Furthermore, the trend in prevalence of diabetes between 1988 to 1994 and 2011 to 2012 increased in the overall subgroup analyses.

Practice Pearls:

  • The prevalence of prediabetes was 37% to 38%; therefore, researchers note that approximately 50% of the population was estimated to have either diabetes or prediabetes.
  • Plateauing trends in prevalence of diabetes mark possibly better screening methods and survival among diagnosed patients.
  • Although improvements have been made, the increased cost to healthcare in managing diabetes requires sustained efforts by all clinicians.

Menke, Andy, et al. “Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012.” Journal of the American Medical Association 314.10 (2015): 1021.