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Chronic Kidney Disease (CKD) Surveillance System

Indicator Details: Percentage with Diabetesa
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a Self-Report, participant report of diabetes diagnosis (main definition); Fasting Glu, fasting glucose ≥126 mg/dl (fasting morning sample subset only); A1C, glycohemoglobin ≥6.5%; Meds, reporting prescribed diabetes medications; Fasting Glu/Meds, either fasting glucose ≥126 mg/dl or prescribed diabetes medications; Tolerance, oral glucose tolerance ≥200 mg/dl (subset without diagnosed diabetes; 2005-2014 only). 

The prevalence of diabetes in U.S. adults ranged from 4% to 10% in 2013-2014, depending on the definition. Overall, 10% adults reported having diabetes, whereas 8%-10% had fasting glucose or glycohemoglobin levels indicating diabetes. From 1999 to 2014, the prevalence of diabetes has signifiantly increased (p <0.05) for all definitions.

The prevalence of self-reported diagnosed diabetes has increased from 6.3% in 1999-2000 to 10.1% in 2013-2014, likely because of an increased diagnosis and patient awareness of diabetes in this time period.
Chart Explanation: Over the 16-year period, 6.6%-10.1% of participants reported having diabetes; 6.5%-13.3% had glycohemoglobin (hemoglobin A1C or “A1C”) of 6.5% or higher, indicating diabetes. Identifying diabetes with a fasting glucose cut-off of 126 mg/dl increased from 6.8% in 1999-2000 to 10.2% in 2013-2014 (p <0.001). Among those eligible for oral glucose tolerance testing (i.e., not those with diagnosed diabetes), 4.2% had oral glucose tolerance above the diabetes cutoff in the most recent years. This percent has remained around the same over the 16-year period. The percent of diabetes defined only by medication use, increased from 5.5% to 9.5% (p <0.001), while an increase of 7.9% to 13.3% was identified for those who had diabetes defined by either fasting glucose >= 126 mg/dl or medication use.

In 2013-2014, 10.1% of NHANES participants reported having diabetes, vs. 6.3% in 1999-2000 (P<0.001 for linear trend in percentage over time). The guidelines for diagnosing diabetes changed in 2003 to reflect lower fasting glucose normal limits (Expert Committee on Diagnosis and Classification of Diabetes Mellitus, 2003) and to reflect measurement of glycohemoglobin (which does not require fasting) as an acceptable diagnostic test for diabetes (American Diabetes Association, 2010). Thus, this increasing trend is likely to reflect increased diagnosis as well as increased prevalence of diabetes.
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.
Description of MeasurePrevalence of diabetes mellitus and glycemic control in the general population
Data SourceNCHS
Type of Data SourcePublic
Health Care System DataNo
Regional or National?National
Demographic GroupNon-institutionalized U.S. residents aged 12+ years (20+ for adults)
NumeratorNon-pregnant participants with completed surveys or fasting glucose levels who report having diabetes (or with elevated fasting glucose)
DenominatorNon-pregnant participants with completed surveys (or fasting glucose levels)
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
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
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
Suggested Citation:
Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States.