Undiagnosed Diabetes: Predictors and Comorbidities

描述（由申请人提供）：疾病识别是2型糖尿病高质量护理的第一步。在美国，三分之一的糖尿病患者未被确诊。历史上，非白人和男性的未确诊糖尿病发病率较高。2型糖尿病的自然史包括一个相对无症状的临床前阶段，估计持续10-12年。许多患者只有在临床症状和体征显现后才被诊断出来。由于少数民族、低收入、受教育程度低和缺乏医疗保险等因素，某些患者群体可能会延误诊断。此外，这些延迟可能导致2型糖尿病微血管并发症，如神经病变和肾病，以及大血管并发症，如冠状动脉疾病和下肢血管疾病，这些在2型糖尿病诊断时已经存在。疾病预防和健康促进办公室已确定建立国家糖尿病检测方案为优先事项。了解影响2型糖尿病诊断的因素以及未确诊的2型糖尿病的后果将有助于临床医生和政策制定者优化我们的糖尿病治疗方法。这将提高对2型糖尿病的认识，以及旨在减缓与2型糖尿病相关的加速心血管发病率和死亡率的预防策略。我们将在未来两年内使用1999-2000年全国健康和营养检查和调查（NHANES）中具有全国代表性的样本调查这些因素。

DESCRIPTION (provided by applicant): Recognition of disease is the first step in quality care for type 2 diabetes. One-third of diabetes in the United States is undiagnosed. Rates for undiagnosed diabetes have been historically higher in non-whites and in men. The natural history of type 2 diabetes includes a relatively asymptomatic preclinical phase, which has been estimated to last 10-12 years. Many patients are diagnosed only after the clinical symptoms and signs become manifest. Some groups of patients may have delays in diagnosis based on such factors as minority race, low income, low level of education, and lack of health insurance. Furthermore, these delays may lead to type 2 diabetes microvascular complications such as neuropathy and nephropathy, as well as macrovascular complications such as coronary artery disease and lower extremity vascular disease which are already present at the time of diagnosis of type 2 diabetes. The Office of Disease Prevention and Health Promotion has identified the establishment of a National Diabetes Detection Program as a priority. Knowledge of the factors that affect diagnosis of type 2 diabetes and of the consequences of undiagnosed type 2 diabetes will help clinicians and policy makers optimize our approach to diabetes care. This will result in improved recognition of type 2 diabetes, as well as preventive strategies aimed at slowing the accelerated cardiovascular morbidity and mortality associated with type 2 diabetes. We will investigate these factors over the next 2 years using the nationally representative sample present in the National Health and Nutrition Examination and Survey 1999-2000 (NHANES).