Full Accounting of Diabetes and Pre-Diabetes in the U.S. Population in 1988–1994 and 2005–2006

  1. Catherine C. Cowie, PHD1,
  2. Keith F. Rust, PHD2,
  3. Earl S. Ford, MD3,
  4. Mark S. Eberhardt, PHD4,
  5. Danita D. Byrd-Holt5,
  6. Chaoyang Li, MD3,
  7. Desmond E. Williams, MD6,
  8. Edward W. Gregg, PHD6,
  9. Kathleen E. Bainbridge, PHD5,
  10. Sharon H. Saydah, PHD4 and
  11. Linda S. Geiss, MS6
  1. 1National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
  2. 2Westat, Rockville, Maryland
  3. 3Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia
  4. 4National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
  5. 5Social & Scientific Systems, Inc., Silver Spring, Maryland
  6. 6Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
  1. Corresponding author: Catherine C. Cowie, cowiec{at}


OBJECTIVE—We examined the prevalences of diagnosed diabetes, and undiagnosed diabetes and pre-diabetes using fasting and 2-h oral glucose tolerance test values, in the U.S. during 2005–2006. We then compared the prevalences of these conditions with those in 1988–1994.

RESEARCH DESIGN AND METHODS—In 2005–2006, the National Health and Nutrition Examination Survey included a probability sample of 7,267 people aged ≥12 years. Participants were classified according to glycemic status by interview for diagnosed diabetes and by fasting and 2-h glucoses measured in subsamples.

RESULTS—In 2005–2006, the crude prevalence of total diabetes in people aged ≥20 years was 12.9%, of which ∼40% was undiagnosed. In people aged ≥20 years, the crude prevalence of impaired fasting glucose was 25.7% and of impaired glucose tolerance was 13.8%, with almost 30% having either. Over 40% of individuals had diabetes or pre-diabetes. Almost one-third of the elderly had diabetes, and three-quarters had diabetes or pre-diabetes. Compared with non-Hispanic whites, age- and sex-standardized prevalence of diagnosed diabetes was approximately twice as high in non-Hispanic blacks (P < 0.0001) and Mexican Americans (P = 0.0001), whereas undiagnosed diabetes was not higher. Crude prevalence of diagnosed diabetes in people aged ≥20 years rose from 5.1% in 1988–1994 to 7.7% in 2005–2006 (P = 0.0001); this was significant after accounting for differences in age and sex, particularly in non-Hispanic blacks. Prevalences of undiagnosed diabetes and pre-diabetes were generally stable, although the proportion of total diabetes that was undiagnosed decreased in Mexican Americans.

CONCLUSIONS—Over 40% of people aged ≥20 years have hyperglycemic conditions, and prevalence is higher in minorities. Diagnosed diabetes has increased over time, but other conditions have been relatively stable.


  • Published ahead of print at on 18 November 2008.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health and the Centers for Disease Control and Prevention.

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    • Accepted November 11, 2008.
    • Received July 11, 2008.
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