Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012
Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012
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DOI：
10.1001/jama.2015.10029
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发表时间：
2015-09-08
影响因子：
120.7
通讯作者：
Cowie, Catherine C.
中科院分区：
文献类型：
--
作者：
Menke, Andy;Casagrande, Sarah;Cowie, Catherine C.
重要性以前的研究表明，在美国糖尿病的患病率不断增加。新的美国数据可用于估计糖尿病的患病率和趋势。目的使用国家健康和营养调查（NHANES）数据估计总糖尿病、确诊糖尿病和未确诊糖尿病的近期患病率和更新美国趋势。和参与者1988-1994年和1999-2012年间对美国平民、非机构化人口的全国代表性样本进行的横断面调查; 2011-2012年的2781名成年人被用于估计最近的患病率，1988-2010年的另外23634名成年人被用于估计趋势。（1）血红蛋白A（1c）水平为6.5%或更高，或空腹血糖（FPG）水平为126 mg/dL或更高（血红蛋白A1 c或FPG定义）或（2）另外包括2小时血糖（2小时PG）水平≥ 200 mg/dL（血红蛋白A1 c、FPG或2小时PG定义）。前驱糖尿病定义为血红蛋白A1 c水平为5.7%至6.4%，FPG水平为100 mg/dL至125 mg/dL，或2小时PG水平为140 mg/dL至199 mg/dL。（使用血红蛋白A1 c、FPG或糖尿病和前驱糖尿病的2小时PG定义）为14.3%（95% CI，12.2%-16.8%）总糖尿病，9.1%（95%CI，7.8%-10.6%）诊断糖尿病，5.2%未确诊的糖尿病患者占38.0%（95%CI，4.0%-6.9%），糖尿病前期患者占38.0%（95%CI，34.7%-41.3%）;在糖尿病患者中，未确诊者占36.4%（95%CI，30.5%-42.7%）。未校正的总糖尿病患病率（使用血红蛋白A1 c或FPG定义）为12.3%（95% CI，10.8%-14.1%）;在糖尿病患者中，25.2%（95% CI，21.1%-29.8%）未诊断。与非西班牙裔白色参与者相比，（11.3%[95% CI，9.0%-14.1%]），总糖尿病的年龄标准化患病率（使用血红蛋白A1 c，FPG或2小时PG定义）在非西班牙裔黑人参与者中较高（21.8%[95% CI，17.7%-26.7%]; P < .001），非西班牙裔亚裔受试者（20.6%[95% CI，15.0%-27.6%]; P = 0.007），西班牙裔参与者（22.6%[95% CI，18.4%-27.5%]; P <0.001）。非西班牙裔亚裔受试者（50.9%[95% CI，38.3%-63.4%]; P = 0.004）和西班牙裔受试者（49.0% [95% CI，40.8%-57.2%]; P = 0.02）中未诊断病例的年龄标准化百分比高于所有其他种族/民族。总糖尿病的年龄标准化患病率（使用血红蛋白A1 c或FPG定义）从9.8%（95% CI，8.9%-10.6%）从1988-1994年的10.8%（95%置信区间，9.5%-12.0%）降至12.4%（95% CI，10.8%-14.2%）（趋势P < .001），在每个年龄组、男女、每个种族/族裔组、所有教育水平中均显著增加，结论和相关性2011-2012年，根据所用标准，美国成年人糖尿病的估计患病率为12%至14%，非西班牙裔黑人、非西班牙裔亚洲人和西班牙裔参与者的患病率较高。在1988-1994年和2011-2012年期间，糖尿病的患病率在总人口和所有评估的亚组中均有所增加。
IMPORTANCE Previous studies have shown increasing prevalence of diabetes in the United States. New US data are available to estimate prevalence of and trends in diabetes.OBJECTIVE To estimate the recent prevalence and update US trends in total diabetes, diagnosed diabetes, and undiagnosed diabetes using National Health and Nutrition Examination Survey (NHANES) data.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional surveys conducted between 1988-1994 and 1999-2012 of nationally representative samples of the civilian, noninstitutionalized US population; 2781 adults from 2011-2012 were used to estimate recent prevalence and an additional 23 634 adults from 1988-2010 were used to estimate trends.MAIN OUTCOMES AND MEASURES The prevalence of diabetes was defined using a previous diagnosis of diabetes or, if diabetes was not previously diagnosed, by (1) a hemoglobin A(1c) level of 6.5% or greater or a fasting plasma glucose (FPG) level of 126 mg/dL or greater (hemoglobin A1c or FPG definition) or (2) additionally including 2-hour plasma glucose (2-hour PG) level of 200mg/dL or greater (hemoglobin A1c, FPG, or 2-hour PG definition). Prediabetes was defined as a hemoglobin A1c level of 5.7% to 6.4%, an FPG level of 100 mg/dL to 125 mg/dL, or a 2-hour PG level of 140 mg/dL to 199 mg/dL.RESULTS In the overall 2011-2012 population, the unadjusted prevalence (using the hemoglobin A1c, FPG, or 2-hour PG definitions for diabetes and prediabetes) was 14.3%(95% CI, 12.2%-16.8%) for total diabetes, 9.1% (95% CI, 7.8%-10.6%) for diagnosed diabetes, 5.2% (95% CI, 4.0%-6.9%) for undiagnosed diabetes, and 38.0%(95% CI, 34.7%-41.3%) for prediabetes; among those with diabetes, 36.4%(95% CI, 30.5%-42.7%) were undiagnosed. The unadjusted prevalence of total diabetes (using the hemoglobin A1c or FPG definition) was 12.3%(95% CI, 10.8%-14.1%); among those with diabetes, 25.2%(95% CI, 21.1%-29.8%) were undiagnosed. Compared with non-Hispanic white participants (11.3%[95% CI, 9.0%-14.1%]), the age-standardized prevalence of total diabetes (using the hemoglobin A1c, FPG, or 2-hour PG definition) was higher among non-Hispanic black participants (21.8%[95% CI, 17.7%-26.7%]; P < .001), non-Hispanic Asian participants (20.6%[95% CI, 15.0%-27.6%]; P = .007), and Hispanic participants (22.6%[95% CI, 18.4%-27.5%]; P < .001). The age-standardized percentage of cases that were undiagnosed was higher among non-Hispanic Asian participants (50.9%[95% CI, 38.3%-63.4%]; P = .004) and Hispanic participants (49.0% [95% CI, 40.8%-57.2%]; P = .02) than all other racial/ethnic groups. The age-standardized prevalence of total diabetes (using the hemoglobin A1c or FPG definition) increased from 9.8%(95% CI, 8.9%-10.6%) in 1988-1994 to 10.8%(95% CI, 9.5%-12.0%) in 2001-2002 to 12.4%(95% CI, 10.8%-14.2%) in 2011-2012 (P < .001 for trend) and increased significantly in every age group, in both sexes, in every racial/ethnic group, by all education levels, and in all poverty income ratio tertiles.CONCLUSIONS AND RELEVANCE In 2011-2012, the estimated prevalence of diabetes was 12% to 14% among US adults, depending on the criteria used, with a higher prevalence among participants who were non-Hispanic black, non-Hispanic Asian, and Hispanic. Between 1988-1994 and 2011-2012, the prevalence of diabetes increased in the overall population and in all subgroups evaluated.