About 73% to 80% of U.S. adults with diabetes were aware of their disease during 1999 to 2014. Throughout the 16 years, more than half were treated for diabetes with medication (over 60% with hemoglobin A1C levels ≥ 6.5%); and with time, the percentage significantly increased (p <0.001) to more than half of participants being treated with diabetes medication were controlled (over 50% with hemoglobin A1C <7%).
Chart Explanation: Of participants who had diabetes by either measured hemoglobin A1C or reported use of diabetes medications, 77.0% were aware of their condition during 2013-2014. Very little change was observed in awareness during 1999 to 2014. In recent years, 48.7% of participants who had diabetes by either measured fasting glucose or reported use of diabetes medications, were being treated for their condition with medications. Participants who were on diabetes medications had low proportions of normal fasting glucose levels (9.5% <100 mg/dl, compared with 30.0% <125 mg/dl and 54.8% <150 mg/dl) for participants not taking medication, indicating that glycemic control in these individuals may be generally poor. These participants receiving treatment had an average hemoglobin A1C level of 6.3%, with 48.7% below the currently recommended cutoff of 6.5%. Over time, the percent of participants being treated for their diabetes has significantly increased from 61.5% in 1999-2000 to 72.6% in 2013-2014 (p <0.001).
The NHANES (National Health and Nutrition Examination Survey) is a nationally representative, cross-sectional survey that is currently conducted every 2 years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
Diabetes-associated nephropathy is one of the two main causes of CKD. Diabetic nephropathy accounts for 30-40% of CKD and 44% of incident ESRD in the United States (United States Renal Data System, 2011). Additionally, diabetes-related CKD is associated with high rates of morbidity and mortality (Foley et al., 2005; Go, Chertow, Fan, McCulloch, & Hsu, 2004). Thus, assessing the burden of this risk factor is essential to CKD surveillance. The NHANES surveys are currently conducted every 2 years by the CDC's National Center for Health Statistics to examine disease prevalence and trends over time in different cross-sectional representative samples of noninstitutionalized U.S. civilian residents. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center (MEC). Here we examined data from the 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014 NHANES. Self-reported diabetes was defined by answer of “yes” to the question “have you ever been told by a doctor or other health professional that you have diabetes or sugar diabetes?” Glycohemoglobin, which was approved as a diagnostic test for diabetes in 2010 (American Diabetes Association, 2010), was measured in all participants; fasting glucose and oral glucose tolerance tests (2005-2014 only) were conducted in subsets of the NHANES participants. Medications were recorded from prescription bottles during the interview; metformin HCL, insulin, glimepiride, glipizide, glyburide, pioglitazone, rosiglitazone, meglitinides, DPP-4 inhibitors, GLP-1 receptors, SGLT2 inhibitors and any combination thereof were considered diabetes medications.
| Field | Data |
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| Description of Measure | Prevalence of diabetes mellitus and glycemic control in the general population |
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| Data Source | NCHS |
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| Type of Data Source | Public |
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| Data Set | NHANES |
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| Health Care System Data | No |
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| Regional or National? | National |
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| Demographic Group | Non-institutionalized U.S. residents aged 12+ years (20+ for adults) |
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| Numerator | Non-pregnant participants with completed surveys or fasting glucose levels who report having diabetes (or with elevated fasting glucose) |
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| Denominator | Non-pregnant participants with completed surveys (or fasting glucose levels) |
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| Primary Data Source Indicator | diq010: “Other than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?” yes/no |
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| Primary Indicator Method of Measurement | Questionnaire (interviewer-administered); ages 1+ |
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| Secondary (1) Variable | lbxglu: Fasting plasma glucose (subsample) |
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| Secondary (1) Indicator Method of Measurement | Examination/Laboratory |
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| Secondary (2) Variable | rhd143, rhd141/rhd140, urxpreg: current pregnancy |
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| Secondary (2) Indicator Method of Measurement | Questionnaire (interviewer-administered) or exam (urine pregnancy status) |
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| Secondary (3) Variable | nhcode/rxddrgid: generic drug codes |
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| Secondary (3) Indicator Method of Measurement | Questionnaire (interviewer-administered), with recording of medications from Rx bottles |
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| Frequency of Measurement (Primary) | Once (cross-sectional) |
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| U.S. Region Covered by Primary Variable | All |
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| Period Currently Available | 1999–2014 |
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| Pending Data | 2014-2015 |
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| Additional Data Items of Interest | Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, BMI, hypertension by self-report) |
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| Limitations of Indicator | Fasting plasma glucose only on a subsample of morning participants who were fasting; OGTT available for 2005-2014 only |
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| Analytic Considerations | Appropriate NHANES survey weights, including fasting and OGTT weights, must be used for all analyses; glucose values must be converted for 2005-2006 and 2007-2008; OGTT only measured on those without diabetes |
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References and Sources:
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Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
http://www.ncbi.nlm.nih.gov/pubmed/15385656
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Foley RN, Murray AM, Li S, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16(2):489-95.
http://www.ncbi.nlm.nih.gov/pubmed/15590763
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National Institute of Diabetes and Digestive and Kidney Diseases. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD: National Institutes of Health; 2011.
https://www.usrds.org/reference.aspx
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American Diabetes Association. Standards of medical care in diabetes—2010 (position statement). Diabetes Care . 2010;33 Suppl 1:S11-61.