Search

OBJECTIVE Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample. RESEARCH DESIGN AND METHODS We included 2,236 adults aged ≥65 years without known diabetes from the 2005–2016 National Health and Nutrition Examination Survey. Diabetes was defined using: 1) the Endocrine Society approach (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-h plasma glucose ≥200 mg/dL among those with HbA1c 5.7–6.4% or FPG 100–125 mg/dL); and 2) a standard approach (HbA1c ≥6.5% or FPG ≥126 mg/dL). Treatment eligibility was defined using HbA1c cut points (≥7% to ≥9%). OGTT screening costs were estimated using Medicare fee schedules. RESULTS Diabetes prevalence was 15.7% (∼5.0 million) using the Endocrine Society’s approach and 7.3% (∼2.3 million) using the standard approach. Treatment eligibility ranged from 5.4% to 0.06% and 11.8% to 1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c CONCLUSIONS Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.

OBJECTIVE Leisure-time physical activity (LTPA) has been shown to prevent or delay the development of diabetes. However, little research exists examining how other domains of PA (e.g., occupation based [OPA] and transportation based [TPA]) are associated with diabetes prevalence across diverse racial/ethnic groups. We examined associations between OPA, TPA, and LTPA and diabetes prevalence and whether associations differed by race/ethnicity. RESEARCH DESIGN AND METHODS Participants in the 2011–2016 National Health and Nutrition Examination Survey (NHANES) self-reported domain-specific PA. Diabetes status was determined by self-reported doctor/health professional–diagnosis of diabetes or a glycosylated hemoglobin (HbA1c) measurement of ≥6.5% (48 mmol/mol). Multivariable log binomial models examined differences in diabetes prevalence by PA level in each domain and total PA among Latinos (n = 3,931), non-Latino whites (n = 6,079), and non-Latino blacks (n = 3,659). RESULTS Whites reported the highest prevalence of achieving PA guidelines (64.9%), followed by Latinos (61.6%) and non-Latino blacks (60.9%; P < 0.0009). Participants achieving PA guidelines were 19–32% less likely to have diabetes depending on PA domain in adjusted models. Diabetes prevalence was consistently higher among non-Latino blacks (17.1%) and Latinos (14.1%) compared with non-Latino whites (10.7%; P < 0.0001), but interaction results showed the protective effect of PA was similar across PA domain and race/ethnicity—except within TPA, where the protective effect was 4% greater among non-Latino whites compared with Latinos (adjusted difference in risk differences 0.04, P = 0.01). CONCLUSIONS PA policies and programs, beyond LTPA, can be leveraged to reduce diabetes prevalence among all population groups. Future studies are needed to confirm potentially differential effects of transportation-based active living on diabetes prevalence across race/ethnicity.

OBJECTIVE Previous analyses of diabetes prevalence in the U.S. have considered either only large geographic regions or only individuals in whom diabetes had been diagnosed. We estimated county-level trends in the prevalence of diagnosed, undiagnosed, and total diabetes as well as rates of diagnosis and effective treatment from 1999 to 2012. RESEARCH DESIGN AND METHODS We used a two-stage modeling procedure. In the first stage, self-reported and biomarker data from the National Health and Nutrition Examination Survey (NHANES) were used to build models for predicting true diabetes status, which were applied to impute true diabetes status for respondents in the Behavioral Risk Factor Surveillance System (BRFSS). In the second stage, small area models were fit to imputed BRFSS data to derive county-level estimates of diagnosed, undiagnosed, and total diabetes prevalence, as well as rates of diabetes diagnosis and effective treatment. RESULTS In 2012, total diabetes prevalence ranged from 8.8% to 26.4% among counties, whereas the proportion of the total number of cases that had been diagnosed ranged from 59.1% to 79.8%, and the proportion of successfully treated individuals ranged from 19.4% to 31.0%. Total diabetes prevalence increased in all counties between 1999 and 2012; however, the rate of increase varied widely. Over the same period, rates of diagnosis increased in all counties, while rates of effective treatment stagnated. CONCLUSIONS Our findings demonstrate substantial disparities in diabetes prevalence, rates of diagnosis, and rates of effective treatment within the U.S. These findings should be used to target high-burden areas and select the right mix of public health strategies.

We thank Del Buono et al. (1) for their interest in our study about diabetes in Takotsubo syndrome (TTS) (2), and we are pleased that our work was inspiring for their analysis. The potential causal association between diabetes and the occurrence of TTS is obviously an extremely controversially discussed issue. Previously, the observation of a low diabetes prevalence in some TTS populations led to the assumption that diabetes is protective for the emergence of the disease (3). Diabetic cardiovascular autonomic neuropathy leading to catecholamine hyposecretion and amelioration of adrenergic effects to …

OBJECTIVE Health care spending on diabetes in the U.S. has increased dramatically over the past several decades. This research describes health care spending on diabetes to quantify how that spending has changed from 1996 to 2013 and to determine what drivers are increasing spending. RESEARCH DESIGN AND METHODS Spending estimates were extracted from the Institute for Health Metrics and Evaluation’s Disease Expenditure 2013 database. Estimates were produced for each year from 1996 to 2013 for each of 38 age and sex groups and six types of care. Data on disease burden were extracted from the Global Burden of Disease 2016 study. We analyzed the drivers of spending by measuring the impact of population growth and aging and changes in diabetes prevalence, service utilization, and spending per encounter. RESULTS Spending on diabetes in the U.S. increased from $37 billion (95% uncertainty interval $32–$42 billion) in 1996 to $101 billion ($97–$107 billion) in 2013. The greatest amount of health care spending on diabetes in 2013 occurred in prescribed retail pharmaceuticals (57.6% [53.8–62.1%] of spending growth) followed by ambulatory care (23.5% [21.7–25.7%]). Between 1996 and 2013, pharmaceutical spending increased by 327.0% (222.9–456.6%). This increase can be attributed to changes in demography, increased disease prevalence, increased service utilization, and, especially, increases in spending per encounter, which increased pharmaceutical spending by 144.0% (87.3–197.3%) between 1996 and 2013. CONCLUSIONS Health care spending on diabetes in the U.S. has increased, and spending per encounter has been the biggest driver. This information can help policy makers who are attempting to control future spending on diabetes.

Nanditha et al. (1) recently reported on time trends in diabetes prevalence in Tamil Nadu, India, between 2006 and 2016. They found stronger increases in prevalence in periurban villages (PUVs) and towns compared with cities, while the absolute prevalence was still highest in cities. Based on these results, we estimate the incidence of diabetes in Tamil Nadu in order to provide further insights into the diabetes epidemic in India. It has been shown that mathematical relationships can be used to estimate the age-specific incidence rate using input values for the prevalence, its temporal change, the mortality rate of the general population, and the mortality …

OBJECTIVE—Lower-extremity amputation is a common complication among patients with diabetes throughout the world. However, few data exist on the actual impact of the recent moves to improve the management of diabetic foot ulcers to reduce the incidence of lower-extremity amputations. The aim was to determine the incidence of lower-extremity amputations among diabetic patients from 1991 to 2000 in the Netherlands. RESEARCH DESIGN AND METHODS—A secondary database containing information regarding all hospital admissions in which a lower-extremity amputation occurred for the years 1991–2000 was obtained from the Dutch National Medical Register. Because a patient-unique identifier was included, multiple amputations and hospitalizations for a single individual could be identified. Furthermore, age- and sex-specific diabetes prevalence rates were calculated using a 3-year average for every year, calculating the total diabetic population in the Netherlands at risk for every year. RESULTS—In 1991, a total of 1,687 patients with diabetes had been admitted 1,865 times for 2,409 amputations. In 2000, a total of 1,673 patients with diabetes were admitted 1,932 times for 2,448 amputations. The overall incidence rates of the number of patients who underwent lower-extremity amputation decreased over the years from 55.0 to 36.3 per 10,000 patients with diabetes (P < 0.05). Both in men (71.8 vs. 46.1, P < 0.05) and women (45.0 vs. 28.0, P < 0.05) with diabetes, a significant decrease could be observed. Mean duration of hospitalization decreased from 45.0 days (SD 44.4) in 1991 to 36.2 days (SD 38.4) in 2000; decreases were observed for both men and women. CONCLUSIONS—Over the years observed in this study, the incidence rates of diabetes-related lower-extremity amputation in the Netherlands was found to decrease in both men (36%) and women (38%) with diabetes. Furthermore, the duration of hospitalization decreased over time.

Worldwide diabetes prevalence is projected to increase from 8.3% (382 million adults) in 2013 to 8.8% (592 million adults) by 2035 (1), with more than 80% of cases in low- and middle-income countries. Consistent with this global trend, estimated prevalence of diabetes in Vietnam has risen from 2.9% in 2010 (2) to 5.4% in 2013 (1). However, these estimates derive from studies of hospital admissions or small samples and underrepresent Vietnam’s large rural population. We contribute to the literature by estimating the prevalence of diabetes and exploring its determinants using data from 2011–2013 community diabetes screening programs among adults in rural and urban areas of northern Vietnam. Eligible residents were nonpregnant individuals aged 30–69 years, with at least one risk factor for diabetes verified by physicians. Anthropometry and blood pressure were measured, and lifestyle factors were ascertained …

OBJECTIVE To estimate the prevalence of diabetes in U.S. youth aged RESEARCH DESIGN AND METHODS To address one of its primary aims, the SEARCH for Diabetes in Youth Study identified youth aged RESULTS From a population of 3,458,974 youth aged CONCLUSIONS Diabetes, one of the leading chronic diseases in childhood, affects >190,000 (1 of 433) youth aged

In a recent letter in Diabetes Care , Lockwood (1) presented a statistically significant correlation between statewide diabetes prevalence and statewide total air pollution emissions reported in the Environmental Protection Agency’s (EPA) toxic release inventory (TRI) database ( r = 0.54, P < 0.0001). Lockwood noted that such a correlation does not necessarily result from a causal relationship, but called for further research into understanding the association between air pollution and diabetes. In response, Nicolich (2) took issue with Lockwood’s use of statewide data. To demonstrate that correlations based on statewide data may not show causal relationships, Nicolich presented four highly statistically significant correlations between statewide diabetes prevalence and factors that would not be expected to be causal factors in diabetes: latitude of the state capital, longitude of the state capital, state population, and numerical position of the state name on an alphabetized …

OBJECTIVE The Métis are a distinct Aboriginal people in Canada with a unique history, culture, and language. This study examined diabetes prevalence and care in the Métis of Ontario. RESEARCH DESIGN AND METHODS The 14,480 people in the citizenship registry of the Métis Nation of Ontario were linked with provincial health care databases to determine diabetes prevalence and processes of care. Rates were compared between the Métis and the general Ontario population. RESULTS The age/sex standardized prevalence of diabetes for the Métis was 11.2%, nearly 25% higher than that of the general Ontario population. Métis were more likely to be hospitalized (12.7 vs. 10.7%) or require emergency room visits (36.1 vs. 27.7%). CONCLUSIONS Métis people have an increased burden of diabetes that puts them at risk for complications and morbidity. Ensuring adequate access to and quality of care for diabetes is essential to maintain the health of the Métis people.

The prevalence of diabetes has risen substantially in the past decade. This increase has been linked to an “epidemic” of obesity (1). However, environmental toxins, most notably dioxins, have also been suggested as contributing factors. Because direct exposure data, in the form of measured levels of toxicants in blood, etc., are not yet available from large populations, total air toxicants from the most recent Toxics Release Inventory (TRI) were used to evaluate the relationship between the prevalence of diabetes and environmental toxicants. Data from the 2000 Behavioral Risk Factor Surveillance System (BRFSS) were used to determine diabetes prevalence, by state (1). These data are based on self-reports …

OBJECTIVE To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data. RESEARCH DESIGN AND METHODS Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of ≥ 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents ≥ 40 yr of age in 15 villages in southwestern Alaska. RESULTS Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians. CONCLUSIONS The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.

Diabetes prevalence is unknown in patients with multiple sclerosis (MS). The objective of this study was to estimate the prevalence of both types of diabetes in MS patients. We reviewed the database from our MS center. A total of 1,206 patients were diagnosed and treated at the center for MS in a duration of 6 years (1991–1997). Of those patients, 92 were diagnosed as having diabetes. Health records were reviewed for sex, race, type of diabetes (type 1 versus type 2), age of onset of MS and diabetes, …

Global diabetes prevalence estimates for adults in 2000, which were derived from population-based data using oral glucose tolerance tests, were recently reported by Wild et al. (1). Because there are few OGTT-based data in the European region, estimates from a regional study carried out in the Netherlands were applied to 13 other countries, including Germany (2). For Germany, a prevalence of 4.1% was estimated, which corresponds to 2.6 …

Rathmann and Giani (1) point out that there is a greater diversity of diabetes prevalence in Europe than suggested by our recent article (2) on the global prevalence of diabetes. We agree with this point. Unfortunately, the data from their study (3) in Augsburg, Germany, had not been published when the data for our article were assembled in 2002. As described in the article, we plan to update the estimates of diabetes prevalence and will include the …

Information on diabetes prevalence in the general population is scarce and often based on extrapolations. We evaluated whether prevalence could be estimated from routine data sources.The sources were 1) hospital discharges (2008, n = 828,171), 2) death registry (2007/2008, n = 118,659), and 3) Swiss Health Survey (SHS; 2007, n = 18,665). Persons without diabetes as underlying cause of death (death registry) or principal diagnosis (hospital discharges) were regarded as surrogate for a general population random sample.In those aged 20-84 years, 4.5% of men and 3% of women were expected to have diabetes. By source, estimations were 4.4 and 2.8% (hospital discharges), 3.8 and 3.1% (death registry), and 4.9 and 3.7% (SHS) for men and women, respectively. Among sources, age-sex patterns were similar.In countries with adequate data quality, combination of routine data may provide valid and reliable estimations of diabetes prevalence. Our figures suggest that International Diabetes Federation extrapolations substantially overestimate diabetes prevalence in Switzerland.

In a recent letter in Diabetes Care , Lockwood (1) pointed out that there was a strong correlation ( r = 0.54, P = 0.000057) between the statewide self-reported diabetes prevalence in 2000 and the total statewide air toxic release inventory (TRI) in 1999 for the 50 states and Washington, D.C. He pointed out that “\[although\] \[…\] the correlation between air emissions and the prevalence of diabetes does not prove a cause-and-effect relationship, the significance of the relationship demands attention.” I agree that the correlation does not prove …

We have analyzed data from 3370 OGTTs performed during epidemiologic studies in three different ethnic groups (Micronesian, Polynesian, and Melanesian) in various Pacific countries to examine the value of a single fasting plasma glucose greater than or equal to 140 mg/dl as a diagnostic test for diabetes (defined as 2-h plasma glucose greater than or equal to 200 mg/dl). A fasting plasma glucose greater than or equal to 140 mg/dl is a highly specific test for diabetes, specificity in the various populations ranging from 98.1% to 99.7%. On the other hand, the sensitivity of fasting plasma glucose was not high and varied greatly between the populations (46.2%-79.0%). The predictive value of fasting plasma glucose for the diagnosis of diabetes was lowest in populations with a low diabetes prevalence and improved in higher prevalence groups. These data indicate that a fasting plasma glucose greater than or equal to 140 mg/dl is not a good screening test, apart from populations with a high prevalence of diabetes mellitus, and the 2-h postload plasma glucose is preferable.

The prevalence of diabetes mellitus in the traditional-living population of Wallis Island was low and comparable with that found in other rural Polynesian societies. The diabetes prevalence was 1.9% in men and 3.5% in women; impaired glucose tolerance occurred in 5.0% of men and 8.4% of women. The prevalence of obesity was significantly greater in women than in men (37.4% versus 12%, respectively, were equal to or greater than 140% ideal weight). Subjects with diabetes tended to be more obese and less active than normal subjects, but these differences, although appreciable, were not usually statistically significant. The population engages in considerable physical activity, and this, along with the traditional diet, may be responsible for the relatively low diabetes prevalence.