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Original Research

Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the U.S. Population in 1988–2006

  1. Catherine C. Cowie, PHD1,
  2. Keith F. Rust, PHD2,
  3. Danita D. Byrd-Holt, BBA3,
  4. Edward W. Gregg, PHD4,
  5. Earl S. Ford, MD5,
  6. Linda S. Geiss, MS4,
  7. Kathleen E. Bainbridge, PHD3 and
  8. Judith E. Fradkin, MD1
  1. 1National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;
  2. 2Westat, Rockville, Maryland;
  3. 3Social and Scientific Systems, Silver Spring, Maryland;
  4. 4Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia;
  5. 5Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
  1. Corresponding author: Catherine C. Cowie, cowie{at}nih.gov.
Diabetes Care 2010 Mar; 33(3): 562-568. https://doi.org/10.2337/dc09-1524
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    Figure 1

    Undiagnosed diabetes in the U.S. population aged ≥20 years by three diagnostic criteria—NHANES 2005–2006. Comparisons were calculated among individuals in the OGTT subsample in 2005–2006 (n = 2,017); consequently some estimates may differ slightly from those in Table 1. The thresholds of diagnostic criteria for diabetes were A1C ≥6.5%, FPG ≥7.0 mmol/1, and 2-h glucose ≥11.1 mmol/1. Point estimates (%) and 95% CIs for the categories are: A1C alone = 0.3 (0.0–0.7); FPG alone = 0.2 (0.0–0.5); 2-h glucose alone = 2.5 (1.9–3.2); A1C and FPG not 2-h glucose = 0.0; A1C and 2-h glucose not FPG = 0.1 (0.0–0.3); FPG and 2-h glucose not A1C = 1.0 (0.3–1.8); A1C, FPG, and 2-h glucose = 1.2 (0.5–2.0); total A1C = 1.6 (0.7–2.5); total FPG = 2.5 (1.2–3.8); total 2-h glucose = 4.9 (3.4–6.4); diagnosed diabetes = 7.8 (6.7–8.8); nodiabetes = 86.9 (84.6–89.1).

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  • Table 1

    Crude prevalence of diagnosed diabetes, undiagnosed diabetes (A1C ≥6.5%), total diabetes (diagnosed and undiagnosed combined), total diabetes that is undiagnosed, and at high risk for diabetes (A1C ≥6.0 to <6.5%), by age, sex, and race/ethnicity: NHANES 2003–2006 (n = 13,094)

    Diagnosed diabetesUndiagnosed diabetesTotal diabetesTotal diabetes that is undiagnosedAt high risk for diabetes
    Combined age-groups (years)
        ≥126.8 (6.1–7.5)1.6 (1.2–1.9)8.4 (7.6–9.2)19.0 (15.2–22.7)3.1 (2.7–3.4)
        ≥207.8 (7.0–8.6)1.8 (1.4–2.2)9.6 (8.7–10.5)19.0 (15.2–22.7)3.5 (3.0–3.9)
        ≥6517.7 (15.6–19.7)3.5 (2.6–4.3)21.1 (18.7–23.5)16.3 (12.9–19.8)8.1 (6.6–9.6)
    Age-specific groups (years)
        12–190.4 (0.2–0.7)0.1 (0.0–0.2)0.5 (0.2–0.8)17.5 (0.0–36.4)0.3 (0.1–0.5)
        20–391.9 (1.4–2.4)0.6 (0.3–0.9)2.5 (1.9–3.1)25.6 (16.3–35.0)0.7 (0.4–1.0)
        40–598.1 (6.9–9.4)2.0 (1.3–2.7)10.1 (8.7–11.5)19.5 (13.1–25.9)3.7 (3.1–4.4)
        60–7417.6 (15.7–19.5)3.5 (2.1–4.9)21.1 (18.7–23.4)16.5 (10.7–22.2)7.1 (5.5–8.8)
        ≥7515.2 (12.9–17.6)3.5 (2.4–4.6)18.7 (16.6–20.9)18.8 (12.7–24.9)8.7 (7.2–10.2)
    Sex by age (years)
        Men
            ≥126.5 (5.6–7.5)1.8 (1.2–2.4)8.3 (7.4–9.3)21.8 (15.2–28.4)3.1 (2.7–3.6)
            ≥207.5 (6.4–8.5)2.1 (1.4–2.8)9.6 (8.5–10.6)21.8 (15.2–28.4)3.5 (3.0–4.1)
            ≥6518.1 (15.3–20.9)3.8 (2.2–5.3)21.8 (18.5–25.2)17.2 (11.2–23.2)8.3 (6.6–10.0)
        Women
            ≥127.1 (6.2–7.9)1.4 (1.1–1.7)8.4 (7.4–9.4)16.3 (13.3–19.3)3.0 (2.4–3.6)
            ≥208.0 (7.1–8.9)1.6 (1.2–1.9)9.6 (8.4–10.7)16.3 (13.3–19.3)3.4 (2.7–4.1)
            ≥6517.4 (14.8–20.0)3.2 (2.2–4.3)20.6 (17.5–23.7)15.7 (11.8–19.5)7.9 (6.0–9.9)
    Race/ethnicity by age (years)
        Non-Hispanic white
            ≥126.2 (5.3–7.1)1.3 (0.8–1.8)7.5 (6.5–8.5)17.5 (12.1–22.9)2.7 (2.3–3.2)
            ≥206.9 (6.0–7.9)1.5 (0.9–2.0)8.4 (7.3–9.5)17.5 (12.1–23.0)3.1 (2.6–3.6)
            ≥6516.0 (13.8–18.2)2.8 (1.9–3.8)18.8 (16.2–21.4)15.1 (10.9–19.3)7.7 (6.1–9.3)
        Non-Hispanic black
            ≥129.3 (8.0–10.5)2.1 (1.6–2.5)11.4 (10.0–12.7)18.3 (14.6–21.9)5.7 (4.7–6.6)
            ≥2011.2 (9.7–12.6)2.5 (1.9–3.0)13.7 (12.1–15.2)18.2 (14.5–21.9)6.7 (5.6–7.8)
            ≥6525.2 (19.7–30.7)7.5 (4.9–10.1)32.7 (26.8–38.5)22.9 (15.4–30.4)13.2 (9.8–16.7)
        Mexican American
            ≥126.5 (5.3–7.7)2.5 (1.5–3.5)9.0 (7.4–10.6)27.9 (19.4–36.3)2.3 (1.5–3.1)
            ≥207.9 (6.5–9.2)3.0 (1.8–4.2)10.9 (9.0–12.8)27.7 (19.2–36.2)2.8 (1.8–3.7)
            ≥6526.6 (22.5–30.7)5.2 (2.5–8.0)31.8 (28.4–35.2)16.4 (7.9–25.0)8.3 (3.7–12.8)
    • Data are % (95% CI). Diagnosed diabetes determined by self-report on interview. Values by age alone and by sex include those of race/ethnic groups not listed separately.

  • Table 2

    Standardized prevalence of diagnosed diabetes, undiagnosed diabetes (A1C ≥6.5%), total diabetes (diagnosed and undiagnosed combined), percent of total diabetes that is undiagnosed, and at high risk of diabetes (A1C ≥6.0 to <6.5%), by age, sex, and race/ethnicity: NHANES 1988–1994, 1999–2002, 2003–2006

    1988–19941999–20022003–2006
    n15,8918,9739,025
    Diagnosed diabetes
        Combined age groups (years)
            ≥205.3 (4.8–5.8)6.6 (5.9–7.3)7.6 (6.9–8.3)
            ≥6512.5 (11.0–13.9)14.9 (13.2–16.6)17.7 (15.6–19.8)
        Age-specific groups (years)
            20–391.1 (0.6–1.6)1.6 (1.0–2.3)1.9 (1.4–2.4)
            40–595.5 (4.6–6.4)6.8 (5.7–7.9)8.1 (6.9–9.4)
            60–7411.9 (10.3–13.5)15.5 (13.9–17.2)17.7 (15.7–19.6)
            ≥7513.7 (11.8–15.6)13.6 (10.6–16.6)15.1 (12.8–17.3)
        Sex (age ≥20 years)
            Men5.3 (4.7–5.8)7.2 (6.2–8.2)7.6 (6.6–8.6)
            Women5.3 (4.6–6.1)6.1 (5.3–6.9)7.6 (6.8–8.4)
        Race/ethnicity (age ≥20 years)
            Non-Hispanic white4.8 (4.2–5.5)5.3 (4.6–6.0)6.3 (5.5–7.0)
            Non-Hispanic black8.4 (7.5–9.2)10.9 (9.4–12.3)12.2 (10.8–13.6)
            Mexican American9.4 (8.5–10.4)10.4 (9.4–11.5)12.0 (10.4–13.6)
    Undiagnosed diabetes
        Combined age groups (years)
            ≥202.1 (1.8–2.5)1.6 (1.3–2.0)1.8 (1.4–2.2)
            ≥654.4 (3.4–5.4)3.2 (2.4–4.0)3.5 (2.6–4.4)
        Age-specific groups (years)
            20–390.4 (0.2–0.6)0.5 (0.1–0.8)0.6 (0.3–0.9)
            40–592.6 (1.9–3.2)1.8 (1.3–2.3)2.0 (1.3–2.7)
            60–744.3 (3.2–5.5)3.7 (2.7–4.7)3.5 (2.1–4.9)
            ≥755.5 (3.8–7.2)3.2 (1.9–4.4)3.6 (2.4–4.8)
        Sex (age ≥20 years)
            Men2.6 (2.1–3.1)2.0 (1.5–2.5)2.1 (1.5–2.7)
            Women1.8 (1.4–2.1)1.3 (1.0–1.7)1.5 (1.2–1.8)
        Race/ethnicity (age ≥20 years)
            Non-Hispanic white1.6 (1.2–1.9)1.2 (0.9–1.5)1.3 (0.9–1.8)
            Non-Hispanic black5.0 (4.3–5.6)3.1 (2.4–3.8)2.7 (2.2–3.3)
            Mexican American4.0 (3.0–4.9)2.7 (2.0–3.4)3.6 (2.3–4.9)
    Total diabetes
        Combined age groups (years)
            ≥207.4 (6.8–8.1)8.2 (7.3–9.1)9.3 (8.6–10.1)
            ≥6516.9 (15.2–18.6)18.1 (16.2–20.1)21.2 (18.8–23.6)
        Age-specific groups (years)
            20–391.5 (1.0–2.0)2.1 (1.3–2.9)2.5 (1.9–3.1)
            40–598.1 (6.8–9.4)8.6 (7.3–10.0)10.1 (8.7–11.5)
            60–7416.2 (14.3–18.1)19.2 (17.1–21.3)21.1 (18.8–23.5)
            ≥7519.2 (16.9–21.6)16.8 (13.6–19.9)18.6 (16.6–20.7)
        Sex (age ≥20 years)
            Men7.8 (7.1–8.6)9.2 (7.9–10.5)9.7 (8.8–10.6)
            Women7.1 (6.2–8.0)7.4 (6.5–8.3)9.1 (8.1–10.1)
        Race/ethnicity (age ≥20 years)
            Non-Hispanic white6.4 (5.6–7.2)6.5 (5.7–7.3)7.6 (6.7–8.5)
            Non-Hispanic black13.3 (12.3–14.4)14.0 (12.6–15.4)14.9 (13.4–16.5)
            Mexican American13.4 (12.2–14.5)13.2 (12.1–14.2)15.6 (14.2–16.9)
    Percent of total diabetes that is undiagnosed
        Combined age groups (years)
            ≥2028.9 (23.2–34.6)20.6 (15.1–26.1)21.5 (16.6–26.4)
            ≥6525.6 (20.5–30.7)17.6 (13.8–21.4)16.4 (12.9–19.9)
        Age-specific groups (years)
            20–3928.1 (15.2–40.9)21.8 (9.9–33.7)25.6 (16.2–34.9)
            40–5931.4 (26.1–36.7)20.4 (15.3–25.6)19.4 (13.3–25.5)
            60–7426.7 (20.8–32.7)19.1 (14.6–23.5)16.4 (10.8–22.0)
            ≥7527.6 (21.1–34.2)19.1 (11.6–26.6)19.2 (12.8–25.7)
        Sex (age ≥20 years)
            Men30.4 (22.7–38.1)22.6 (13.1–32.2)25.4 (16.4–34.3)
            Women27.8 (20.1–35.5)18.7 (11.5–26.0)17.8 (12.4–23.1)
        Race/ethnicity (age ≥20 years)
            Non-Hispanic white19.5 (11.7–27.3)16.9 (10.1–23.8)17.1 (6.5–27.6)
            Non-Hispanic black41.6 (35.2–47.9)26.7 (13.5–40.0)15.7 (8.7–22.7)
            Mexican American44.3 (38.1–50.6)15.2 (11.1–19.3)34.6 (23.0–46.1)
    At high risk for diabetes
        Combined age groups (years)
            ≥204.9 (4.4–5.5)3.2 (2.6–3.7)3.4 (3.0–3.8)
            ≥6510.8 (9.7–11.9)6.6 (5.3–7.9)8.1 (6.6–9.6)
        Age-specific groups (years)
            20–391.8 (1.2–2.3)0.8 (0.5–1.2)0.7 (0.4–1.0)
            40–595.2 (4.3–6.0)3.6 (2.7–4.6)3.7 (3.1–4.4)
            60–749.3 (7.9–10.7)6.5 (4.9–8.2)7.1 (5.5–8.8)
            ≥7512.1 (9.7–14.5)6.9 (5.4–8.4)8.7 (7.2–10.2)
        Sex (age ≥20 years)
            Men5.3 (4.4–6.1)3.3 (2.6–3.9)3.6 (3.1–4.1)
            Women4.6 (4.0–5.2)3.1 (2.4–3.8)3.2 (2.6–3.9)
        Race/ethnicity (age ≥20 years)
            Non-Hispanic white3.7 (3.1–4.2)2.5 (1.9–3.0)2.7 (2.3–3.2)
            Non-Hispanic black12.5 (11.3–13.7)5.9 (4.5–7.3)7.2 (6.2–8.2)
            Mexican American5.9 (4.7–7.2)3.8 (2.9–4.7)3.6 (2.5–4.6)
    • Data are % (95% CI). Diagnosed diabetes determined by self-report on interview. Values by age alone and by sex include those of race/ethnic groups not listed separately. Estimates for the total population aged ≥20 years and for race/ethnic groups were age- and sex-standardized, estimates for age-specific groups including those aged ≥65 years were sex-standardized, and estimates for sex groups were age-standardized (all using the 2000 U.S. Census population).

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Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the U.S. Population in 1988–2006
Catherine C. Cowie, Keith F. Rust, Danita D. Byrd-Holt, Edward W. Gregg, Earl S. Ford, Linda S. Geiss, Kathleen E. Bainbridge, Judith E. Fradkin
Diabetes Care Mar 2010, 33 (3) 562-568; DOI: 10.2337/dc09-1524

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Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the U.S. Population in 1988–2006
Catherine C. Cowie, Keith F. Rust, Danita D. Byrd-Holt, Edward W. Gregg, Earl S. Ford, Linda S. Geiss, Kathleen E. Bainbridge, Judith E. Fradkin
Diabetes Care Mar 2010, 33 (3) 562-568; DOI: 10.2337/dc09-1524
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