Type 2 Diabetes in Older Well-Functioning People: Who Is Undiagnosed?
Data from the Health, Aging, and Body Composition Study
- Lonneke V. Franse, MSc12,
- Mauro Di Bari, MD, PHD13,
- Ron I. Shorr, MD, MS1,
- Helaine E. Resnick, PHD4,
- Jacques T. M. van Eijk, PHD5,
- Doug C. Bauer, MD6,
- Anne B. Newman, MD, PHD7,
- Marco Pahor, MD8 and
- for the Health, Aging, and Body Composition Study Group
- 1Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee
- 2Institute for Research in Extramural Medicine (EMGO), Vrije Universiteit, Amsterdam, the Netherlands
- 3Department of Gerontology and Geriatrics, University of Florence and ‘Careggi’ Hospital, Florence, Italy
- 4MedStar Research Institute, Washington, DC
- 5Department of Medical Sociology, University of Maastricht, Maastricht, the Netherlands
- 6Prevention Sciences Group, University of California, San Francisco, California
- 7Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- 8Sticht Center on Aging, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Abstract
OBJECTIVE—To assess, in an older population, the prevalence of diagnosed and undiagnosed diabetes, the number needed to screen (NNTS) to identify one individual with undiagnosed diabetes, and factors associated with undiagnosed diabetes.
RESEARCH DESIGN AND METHODS—Socioeconomic and health-related factors were assessed at the baseline examination of the Health, Aging, and Body Composition (Health ABC) Study, a cohort of 3,075 well-functioning people aged 70–79 years living in Memphis, Tennessee and Pittsburgh, Pennsylvania (42% blacks and 48% men). Diabetes was defined according to the 1985 World Health Organization criteria (fasting glucose ≥7.8 mmol/l or 2-h glucose ≥11.1 mmol/l) and the 1997 American Diabetes Association criteria (fasting glucose ≥7.0 mmol/l).
RESULTS—The prevalence of diagnosed and undiagnosed diabetes was 15.6 and 8.0%, respectively, among all participants (NNTS 10.6), 13.9 and 9.1% among white men (NNTS 9.5), 7.8 and 7.4% among white women (NNTS 12.4), 22.7 and 9.1% among black men (NNTS 8.5), and 21.6 and 6.2% among black women (NNTS 12.6). In multivariate analyses, compared with individuals without diabetes, individuals with undiagnosed diabetes were more likely to be men and were more likely to have a history of hypertension, higher BMI, and larger waist circumference. NNTS was lowest in men (9.1), individuals with hypertension (8.7), individuals in the highest BMI quartile (6.9), and individuals in the largest waist circumference quartile (6.8).
CONCLUSIONS—In approximately one-third of all older people with diabetes, the condition remains undiagnosed. Screening for diabetes may be more efficient among men and individuals with hypertension, high BMI, and large waist circumference.
- ADA, American Diabetes Association
- Health ABC, Health, Aging, and Body Composition
- NHANES III, Third National Health and Nutrition Examination Survey
- NNTS, number needed to screen
- OGTT, oral glucose tolerance test
- WHO, World Health Organization
Footnotes
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Address correspondence and reprint requests to Lonneke Franse, MSc, Comprehensive Cancer Center South, P.O. Box 231, 5600 AE, Eindhoven, the Netherlands. E-mail: l.vd.poll{at}ikz.nl.
Received for publication 16 May 2001 and accepted in revised form 21 August 2001.
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