Almost 10% of US Adults Have Diabetes, 1 in 4 Is Unaware, Says CDC

Miriam E. Tucker

June 11, 2014

At least 29 million people in the United States — about 9% of the population — now have diabetes, and 1 in 4 does not know it, according to new data from the Centers for Disease Control and Prevention (CDC).

That figure, based on 2012 data from the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey (NHIS), the Indian Health Service, and 2012 US resident population estimates, represents an increase of 3 million since 2010.

The report was published June 10 on the CDC's website.

"These new numbers are alarming and underscore the need for an increased focus on reducing the burden of diabetes in our country," said Ann Albright, PhD, RD, director of CDC's Division of Diabetes Translation, in a statement.

Among the report's other findings:

  • In 2012 alone, 1.7 million people age 20 years or older were newly diagnosed with diabetes.

  • Also in 2012, 208,000 people younger than age 20 had diabetes (types 1 and 2 combined).

  • Age-adjusted percentages of people aged 20 and older with diagnosed diabetes were 7.6% of non-Hispanic whites, 9.0% of Asian-Americans, 12.8% of Hispanics, 13.2% of non-Hispanic blacks, and 15.9% of American Indians/Alaska Natives.

  • More than 1 in 3 people aged 20 years or older, totaling 86 million, have prediabetes.

  • Diabetes and its related complications account for $245 billion in total medical costs and lost work and wages, a jump from $174 billion in 2010.

"Diabetes is costly in both human and economic terms. It's urgent that we take swift action to effectively treat and prevent this serious disease," Dr. Albright said.

How Many With Diabetes Are Undiagnosed?

Also according to the CDC, 8.1 of the total 29.1 million individuals with diabetes, or 28%, are undiagnosed. But that figure conflicts with data published earlier this year by Elizabeth Selvin, PhD, MPH, from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues.

While the Hopkins group also found a dramatic increase in diabetes prevalence using NHANES data, from 6% of the population in 1988–1994 to 10% in 1999–2010, they found that the proportion of undiagnosed cases was just 11% in 2010.

The figures differ because the Hopkins group "confirmed" cases of undiagnosed diabetes by using a combination of both fasting glucose and HbA1c, whereas the CDC simply counted individuals who met just one or the other criterion for defining undiagnosed diabetes. (Both Selvin's team and the CDC used self-report to ascertain diagnosed diabetes.)

Dr. Selvin told Medscape Medical News, "Confirming cases of undiagnosed diabetes with a second test is most consistent with clinical guidelines [from the American Diabetes Association (ADA), among others]."

But the vast majority of epidemiologic studies use only a single measurement of glucose to identify cases of undiagnosed diabetes, she noted. "Because of the high variability in a single measurement of fasting glucose, confirming elevations in glucose with a second test can give a more accurate picture of undiagnosed diabetes in the population."

Edward Gregg, PhD, chief of the epidemiology and statistics branch at the CDC's Division of Diabetes Translation, told Medscape Medical News, "The approach that Dr. Selvin used will produce fewer false positives but will also miss a lot of cases that actually do have diabetes. Thus, we consider the definition that we use to calculate undiagnosed diabetes to be most equivalent to the ADA definition."

Either way, the bottom line is that diabetes is an enormous problem. According to Dr. Albright, "Now is the time to take action. If these numbers continue to rise, 1 in 5 people could have diabetes by the year 2025, and it could be 1 in 3 people by the year 2050. We simply can't sustain this trajectory — the implications are far too great — for our families, our healthcare system, our workforce, our nation."

Earlier this week, the American College of Cardiology, in partnership with the American Diabetes Association, the American College of Physicians, and Joslin Diabetes Center, announced the launch of a new Diabetes Collaborative Registry that may ultimately help improve the identification and management of diabetes in the United States. The first-of-its-kind, multidisciplinary registry is a hat-tip to the fact that many diabetes patients are diagnosed and treated by different healthcare professionals, many of whom may not be directly communicating on patient diagnosis, disease progression, management, and outcomes, a press statement notes.

"We hope that a cross-specialty, clinical registry will ultimately allow us to improve the quality of care — and therefore quality of life — for all people living with diabetes by giving researchers a clearer picture of what's happening to patients at various stages of their disease," American Diabetes Association chief scientific and medical officer Robert E. Ratner, MD, said in a press statement. "Improved data collection should help us improve patient outcomes."

As CDC employees, Dr. Albright and Dr. Gregg have no disclosures. Dr. Selvin also has reported no relevant financial relationships.

Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014. Report

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