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. 2010 Mar;33(3):562-8.
doi: 10.2337/dc09-1524. Epub 2010 Jan 12.

Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006

Catherine C Cowie  1 , Keith F Rust, Danita D Byrd-Holt, Edward W Gregg, Earl S Ford, Linda S Geiss, Kathleen E Bainbridge, Judith E Fradkin
Affiliations

Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006

Catherine C Cowie et al. Diabetes Care. 2010 Mar.

Abstract

OBJECTIVE We 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 METHODS In 2003-2006, the National Health and Nutrition Examination Survey included a probability sample of 14,611 individuals aged > or =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. RESULTS Using A1C criteria, the crude prevalence of total diabetes in adults aged > or =20 years was 9.6% (20.4 million), of which 19.0% was undiagnosed (7.8% diagnosed, 1.8% undiagnosed using A1C > or =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. CONCLUSIONS Although A1C detects much lower prevalences than glucose criteria, hyperglycemic conditions remain high in the U.S., and elderly and minority groups are disproportionately affected.

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Figure 1
Figure 1
Undiagnosed diabetes in the U.S. population aged ≥20 years by three diagnostic criteria—NHANES 2005–2006. Comparisons were calculated among individuals in the OGTT subsample in 2005–2006 (n = 2,017); consequently some estimates may differ slightly from those in Table 1. The thresholds of diagnostic criteria for diabetes were A1C ≥6.5%, FPG ≥7.0 mmol/1, and 2-h glucose ≥11.1 mmol/1. Point estimates (%) and 95% CIs for the categories are: A1C alone = 0.3 (0.0–0.7); FPG alone = 0.2 (0.0–0.5); 2-h glucose alone = 2.5 (1.9–3.2); A1C and FPG not 2-h glucose = 0.0; A1C and 2-h glucose not FPG = 0.1 (0.0–0.3); FPG and 2-h glucose not A1C = 1.0 (0.3–1.8); A1C, FPG, and 2-h glucose = 1.2 (0.5–2.0); total A1C = 1.6 (0.7–2.5); total FPG = 2.5 (1.2–3.8); total 2-h glucose = 4.9 (3.4–6.4); diagnosed diabetes = 7.8 (6.7–8.8); nodiabetes = 86.9 (84.6–89.1).
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