Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S
Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S
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DOI：
10.2337/diacare.27.12.2806
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发表时间：
2004-12-01
期刊：
影响因子：
16.2
通讯作者：
Vinicor, F
中科院分区：
文献类型：
--
作者：
Gregg, EW;Cadwell, BL;Vinicor, F
目的：根据美国过去40年的肥胖状况，研究诊断和未诊断糖尿病的流行趋势以及先前诊断的总病例的比例。研究设计和方法：我们收集了5个连续横断面全国调查的数据：全国健康检查调查I（1960-1962）、全国健康和营养检查调查I（1971-1974）、全国健康和营养检查调查II（1976-1980）、全国健康和营养检查调查III（1988-1994）和全国健康检查调查1999-2000。所有调查均对20-74岁的成年人进行身高和体重测量。在NHANES II、NHANES III和NHANES 1999-2000中，空腹血糖水平大于或等于126 mg/dl用于在未报告糖尿病的个体中识别病例。基于设计的分析和贝叶斯模型估计，在4个BMI组中，糖尿病患病率增加（99.9%）的概率伴随着未确诊糖尿病的不显著增加（2.0-2.4%,66.6%）。这导致糖尿病总人数增加（5.8.3 2%,5.10 99.9%），诊断病例比例略有增加（62-70%,62.4%）。然而，这些趋势因BMI水平而有很大差异。在BMI≥35 kg/m的个体中，诊断出的糖尿病显著增加（从1960年的4.9%，到1976-1980年的8.6%，到1999-2000年的15.1%，概率为99.9%），而未诊断出的糖尿病显著下降（从1976-1980年的12.5%到1999-2000年的3.2%，概率增加4.5%）。因此，在BMI≥35 kg/m的个体中，诊断出糖尿病的比例从41%增加到83%（概率为99.9%）(2)。通过比较，BMI阶层内患病率的变化
OBJECTIVE - To examine trends in the prevalence of diagnosed and undiagnosed diabetes and the proportion of total cases previously diagnosed, according to obesity status in the U.S. over the past 40 years.RESEARCH DESIGN AND METHODS - We assembled data from five consecutive cross-sectional national surveys: National Health Examination Survey I (1960-1962), National Health and Nutrition Examination Survey (NHANES) I (1971-1974), NHANES II (1976-1980), NHANES III (1988-1994), and NHANES 1999-2000. Diagnosed diabetes was ascertained, and height and weight were measured in adults aged 20-74 years in all surveys. In NHANES II, NHANES III, and NHANES 1999-2000, a fasting glucose level greater than or equal to126 mg/dl was used to identify cases among individuals not reporting diabetes. Design-based analyses and Bayesian models estimate the probability that prevalence of diabetes increased within four BMI groups (99.9%) were accompanied by nonsignificant increases in undiagnosed diabetes (2.0-2.4%, 66.6%). This resulted in an increase in total diabetes (5.3 8.2%, >99.9%) and a modest nonsignificant increase in the proportion of cases that were diagnosed (62-70%, 62.4%). However, these trends varied considerably by BMI level. In individuals with BMI greater than or equal to35 kg/m(2), diagnosed diabetes increased markedly (from 4.9% in 1960, to 8.6% during 1976-1980, to 15.1% in 1999-2000; probability >99.9%), whereas undiagnosed diabetes declined considerably (12.5% during 1976-1980 to 3.2% in 1999-2000, probability of increase 4.5%) Therefore, the proportion of total diabetes cases that were diagnosed increased from 41 to 83% (probability 99.9%) among individuals with BMI greater than or equal to35 kg/m(2). By comparison, changes in prevalence within BMI strata