Undiagnosed Diabetes: Predictors and Comorbidities

描述(申请人提供)：对疾病的认识是对2型糖尿病进行优质护理的第一步。在美国，三分之一的糖尿病没有确诊。历史上，非白人和男性的未确诊糖尿病患病率一直较高。2型糖尿病的自然病史包括一个相对无症状的临床前阶段，估计持续10-12年。许多患者是在临床症状和体征明显后才被诊断出来的。一些患者群体可能会因为少数民族、低收入、低教育水平和缺乏医疗保险等因素而延误诊断。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，以及在诊断2型糖尿病时已经存在的大血管并发症，如冠状动脉疾病和下肢血管疾病。疾病预防和健康促进办公室已将建立国家糖尿病检测计划确定为优先事项。了解影响2型糖尿病诊断的因素和未诊断的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。这将导致对2型糖尿病的更好认识，以及旨在减缓与2型糖尿病相关的心血管发病率和死亡率加速上升的预防战略。在接下来的两年里，我们将使用1999-2000年国家健康和营养检查和调查(NHANES)中具有全国代表性的样本来调查这些因素。

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).