Indicator Details: Diabetes Prevalence in CKD Population
Data Sources
 
Stratification and Year Choices:

  Source
  • NHANES

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With adjustment for age, diabetes prevalence (defined by self-report, diabetes medication, or A1C >6.5%) amongst participants aged 60 years or older who have CKD has increased significantly from 27% in 1999-2000 to 35% in 2013-2014 (P-value <0.001). 
Chart Explanation: Within those aged at least 60 years, the age-adjusted prevalence of diabetes in the CKD population was 34.8% in 2013-2014. This was a 28% increase from the prevalence observed in 1999-2000 (27.2%), which presented a significant trend over the 16 year period (P<0.001).
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 an 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 and any combination thereof were considered diabetes medications.
FieldData
Description of MeasurePrevalence of diabetes mellitus and glycemic control in the CKD population
Data SourceNCHS/CDC
Type of Data SourcePublic
Data SetNHANES
Health Care System DataNo
Regional or National?National
Demographic GroupNoninstitutionalized U.S. residents aged 60 years or older
NumeratorNon-pregnant participants with completed surveys or fasting glucose levels who report having diabetes (or with elevated fasting glucose).
DenominatorParticipants with CKD
Definition of CKDStage 1, eGFR ≥ 90 ml/min/1.73 m² and presence of single albuminuria; Stage 2, eGFR 60-89 ml/min/1.73 m² and presence of single albuminuria; Stage 3, eGFR 30-59 ml/min/1.73 m²; Stage 4, 15-29 ml/min/1.73 m²; Stage 5, excluded
Glomerular filtration rateEstimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ  x 0.993age x (1.018 if female) x (1.159 if non-Hispanic black)
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male
ProteinuriaUrinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and >300 mg/g (macroalbuminuria); pregnant women excluded
Primary Data Source Indicatordiq010: “Other than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?” yes/no
Primary Indicator Method of MeasurementQuestionnaire (interviewer-administered); ages 1+
Secondary (1) Variablelbxglu: Fasting plasma glucose (subsample)
Secondary (1) Indicator Method of MeasurementExamination/Laboratory
Secondary (2) Variablerhd143, rhd141/rhd140, urxpreg: current pregnancy
Secondary (2) Indicator Method of MeasurementQuestionnaire (interviewer-administered) or exam (urine pregnancy status)
Secondary (3) Variablenhcode/rxddrgid: generic drug codes
Secondary (3) Indicator Method of MeasurementQuestionnaire (interviewer-administered), with recording of medications from Rx bottles
Frequency of Measurement (Primary)Once (cross-sectional)
U.S. Region Covered by Primary VariableAll
Period Currently Available1999–2014
Pending Data2015-2016
Additional Data Items of InterestStage of CKD, stratification variables of interest (age, gender, race/ethnicity, BMI, hypertension by self-report)
Limitations of IndicatorFasting plasma glucose only on a subsample of morning participants who were fasting; OGTT available for 2005-2014 only
Analytic ConsiderationsAppropriate 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
Age Adjustment
Adjusted for the distribution of age within the sample.
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.
website. http://www.cdc.gov/ckd