Identifying Trends in Undiagnosed Diabetes in U.S. Adults by Using a Confirmatory Definition: A Cross-sectional Study.
Identifying Trends in Undiagnosed Diabetes in U.S. Adults by Using a Confirmatory Definition: A Cross-sectional Study.
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DOI：
10.7326/m17-1272
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发表时间：
2017-12-05
影响因子：
39.2
通讯作者：
Coresh J
中科院分区：
文献类型：
--
作者：
Selvin E;Wang D;Lee AK;Bergenstal RM;Coresh J
人们普遍认为，四分之一到三分之一的糖尿病病例仍未得到诊断。然而，这样的患病率估计可能被夸大的流行病学研究，不使用确认测试，建议的临床诊断标准。根据临床实践指南，使用确证性检测策略提供未确诊糖尿病的国家估计值。横断面研究。1988年至1994年和1999年至2014年的全国健康和营养检查调查结果。20岁及以上的美国成年人。确诊的未确诊糖尿病定义为未确诊糖尿病的患者空腹血糖（≥7.0 mmol/L [≥126 mg/dL]）和血红蛋白A1 c（≥6.5%）水平升高。糖尿病总患病率（确诊加确诊未确诊）从1988年至1994年的5.5%（970万成人）增加到2011年至2014年的10.8%（2550万成人）。过去20年中，确诊的未确诊糖尿病有所增加（从1988年至1994年的0.89%增加到2011年至2014年的1.2%），但随着时间的推移，占糖尿病总病例的比例有所下降。1988年至1994年，未确诊的糖尿病病例占总病例的比例为16.3%;到2011年至2014年，这一估计已降至10.9%。未确诊的糖尿病在超重或肥胖的成年人、老年人、种族/少数民族（包括亚裔美国人）以及缺乏医疗保险或无法获得医疗保健的人中更常见。横截面设计。确定未确诊糖尿病的负担对于监测与筛查和诊断相关的公共卫生工作至关重要。当使用确认性定义时，未确诊的糖尿病在总糖尿病人群中占相对较小的比例;大多数美国糖尿病成年人（约90%）已接受过糖尿病诊断。美国国立卫生研究院、美国国立糖尿病、消化和肾脏疾病研究所以及美国国立心脏、肺和血液研究所。
A common belief is that one quarter to one third of all diabetes cases remain undiagnosed. However, such prevalence estimates may be overstated by epidemiologic studies that do not use confirmatory testing, as recommended by clinical diagnostic criteria. To provide national estimates of undiagnosed diabetes by using a confirmatory testing strategy, in line with clinical practice guidelines. Cross-sectional study. National Health and Nutrition Examination Survey results from 1988 to 1994 and 1999 to 2014. U.S. adults aged 20 years and older. Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose (≥7.0 mmol/L [≥126 mg/dL]) and hemoglobin A1c (≥6.5%) in persons without diagnosed diabetes. The prevalence of total (diagnosed plus confirmed undiagnosed) diabetes increased from 5.5% (9.7 million adults) in 1988 to 1994 to 10.8% (25.5 million adults) in 2011 to 2014. Confirmed undiagnosed diabetes increased during the past 2 decades (from 0.89% in 1988 to 1994 to 1.2% in 2011 to 2014) but has decreased over time as a proportion of total diabetes cases. In 1988 to 1994, the percentage of total diabetes cases that were undiagnosed was 16.3%; by 2011 to 2014, this estimate had decreased to 10.9%. Undiagnosed diabetes was more common in overweight or obese adults, older adults, racial/ethnic minorities (including Asian Americans), and persons lacking health insurance or access to health care. Cross-sectional design. Establishing the burden of undiagnosed diabetes is critical to monitoring public health efforts related to screening and diagnosis. When a confirmatory definition is used, undiagnosed diabetes is a relatively small fraction of the total diabetes population; most U.S. adults with diabetes (~90%) have received a diagnosis of the condition. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.