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Prevalence of Diabetes and Impaired Fasting Glucose in Adults in the U.S. Population

National Health and Nutrition Examination Survey 1999–2002

¹ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
² National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Westat, Rockville, Maryland
³ Social and Scientific Systems, Silver Spring, Maryland
⁴ National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
⁵ Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia

Address correspondence and reprint requests to Catherine C. Cowie, PhD, Director, Diabetes Epidemiology Program, National Institute of Diabetes and Digestive and Kidney Diseases, 6707 Democracy Blvd., Rm. 691, MSC 5460, Bethesda, MD 20892-5460. E-mail: cowiec{at}mail.nih.gov

OBJECTIVE—The purpose of this study was to examine the prevalences of diagnosed and undiagnosed diabetes, and impaired fasting glucose (IFG) in U.S. adults during 1999–2002, and compare prevalences to those in 1988–1994.

RESEARCH DESIGN AND METHODS—The National Health and Nutrition Examination Survey (NHANES) contains a probability sample of adults aged 20 years. In the NHANES 1999–2002, 4,761 adults were classified on glycemic status using standard criteria, based on an interview for diagnosed diabetes and fasting plasma glucose measured in a subsample.

RESULTS—The crude prevalence of total diabetes in 1999–2002 was 9.3% (19.3 million, 2002 U.S. population), consisting of 6.5% diagnosed and 2.8% undiagnosed. An additional 26.0% had IFG, totaling 35.3% (73.3 million) with either diabetes or IFG. The prevalence of total diabetes rose with age, reaching 21.6% for those aged 65 years. The prevalence of diagnosed diabetes was twice as high in non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites (both P < 0.00001), whereas the prevalence of undiagnosed diabetes was similar by race/ethnicity, adjusted for age and sex. The prevalence of diagnosed diabetes was similar by sex, but prevalences of undiagnosed diabetes and IFG were significantly higher in men. The crude prevalence of diagnosed diabetes rose significantly from 5.1% in 1988–1994 to 6.5% in 1999–2002, but the crude prevalences were stable for undiagnosed diabetes (from 2.7 to 2.8%) and IFG (from 24.7 to 26.0%). Results were similar after adjustment for age and sex.

CONCLUSIONS—Although the prevalence of diagnosed diabetes has increased significantly over the last decade, the prevalences of undiagnosed diabetes and IFG have remained relatively stable. Minority groups remain disproportionately affected.

Abbreviations: FPG, fasting plasma glucose • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • NHANES, National Health and Nutrition Examination Survey

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