Type 2 diabetes in older well-functioning people: who is undiagnosed? Data from the Health, Aging, and Body Composition study.
ABSTRACT To assess, in an older population, the prevalence of diagnosed and undiagnosed diabetes, the number needed to screen (NNTS) to identify one individual with undiagnosed diabetes, and factors associated with undiagnosed diabetes.
Socioeconomic and health-related factors were assessed at the baseline examination of the Health, Aging, and Body Composition (Health ABC) Study, a cohort of 3,075 well-functioning people aged 70-79 years living in Memphis, Tennessee and Pittsburgh, Pennsylvania (42% blacks and 48% men). Diabetes was defined according to the 1985 World Health Organization criteria (fasting glucose > or =7.8 mmol/l or 2-h glucose > or =11.1 mmol/l) and the 1997 American Diabetes Association criteria (fasting glucose > or =7.0 mmol/l).
The prevalence of diagnosed and undiagnosed diabetes was 15.6 and 8.0%, respectively, among all participants (NNTS 10.6), 13.9 and 9.1% among white men (NNTS 9.5), 7.8 and 7.4% among white women (NNTS 12.4), 22.7 and 9.1% among black men (NNTS 8.5), and 21.6 and 6.2% among black women (NNTS 12.6). In multivariate analyses, compared with individuals without diabetes, individuals with undiagnosed diabetes were more likely to be men and were more likely to have a history of hypertension, higher BMI, and larger waist circumference. NNTS was lowest in men (9.1), individuals with hypertension (8.7), individuals in the highest BMI quartile (6.9), and individuals in the largest waist circumference quartile (6.8).
In approximately one-third of all older people with diabetes, the condition remains undiagnosed. Screening for diabetes may be more efficient among men and individuals with hypertension, high BMI, and large waist circumference.
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ABSTRACT: To identify sub-populations at risk for diabetes based on having prediabetes. Although food insecurity has been linked to diabetes, to our knowledge, no studies have examined whether food insecure individuals are more likely than fully food secure individuals to have undiagnosed prediabetes. This study was based on a cross-sectional analysis of 6577 adults in the 2005-08 National Health and Nutrition Examination Survey. USDA's Food Security Survey Module, self-reported prediabetes status and clinical measures were examined. Whereas men who were food insecure were more likely than fully food secure men to have undiagnosed prediabetes, no association was observed among women. Prediabetes screening appears warranted for food insecure men.American journal of health behavior 03/2014; 38(2):225-33. DOI:10.5993/AJHB.38.2.8 · 1.31 Impact Factor
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ABSTRACT: Context: Undiagnosed cases of diabetes mellitus constitute a major proportion of diabetic patients in the developing countries due to lack of proper screening and primary care facilities. Generation of evidence on undiagnosed cases is highly important for the estimation of the true burden of this disease. Objectives: The present study was undertaken to explore the proportion of undiagnosed diabetes and associated disorders in a middle aged Bangladeshi population living in the capital city of Bangladesh. Materials and Methods: Under a cross-sectional observational design a group of 254 middle aged (35-60 yrs) subjects (146♂ and 108) were included in the study who previously were unaware about the existence of diabetes or its complications. A 2-sample OGTT was done and blood glucose was estimated by glucose-oxidase method and Serum total cholesterol, HDL and TG by enzymatic colorimetric (Cholesterol Oxidase /Peroxidase, CHOD-PAP) method. Glycemic and other abnormalities were diagnosed and classified as per WHO criteria. Results: Out of the total 254 subjects 34 (15.1%) were found to have type 2 diabetes mellitus (T2DM) and 49 (19.29%) were prediabetics (24.5%-IFG, 75.5% -IGT and 20.4% had combined IFG-IGT). WHR (the indicator of central obesity) was present in higher proportions of diabetic (93.9%) and prediabetics (89.9%) compared to 76.0% control (λ2=8.815; p=0.017). Male subjects had significantly higher central obesity compared to females both in the controls (t=3.929; p<0.0001) and in T2DM groups (t=2.608; p=0.015). Dyslipidemia (judged by triglyceride value) was present among 64.7% in T2DM, 40.8% in Prediabetes and 47.9% in the Controls). In Prediabetes group 80% males had dyslipidemia compared to 20% females (p=0.008). Conclusion: Almost twice the proportion of reported diabetic and prediabetic cases in Bangladesh is still undiagnosed and a substantial proportion of these cases have generalized as well as central obesity and dyslipidemia.Journal of Bio-Science 01/2011; DOI:10.3329/jbs.v19i0.12674
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ABSTRACT: Recent initiatives have focused on primary prevention to delay time to first myocardial infarction (MI). The aim of this study was to evaluate the change in risk factor profile over time in patients without known cardiovascular disease presenting with first MI. In the American Heart Association's Get With The Guidelines-Coronary Artery Disease national registry, 100,884 patients without known cardiovascular disease presenting with acute MI from 408 hospitals were evaluated between 2002 and 2008. The time trends of the proportion of patients with cardiovascular risk factors (nonmodifiable: age >45 years for men or >55 years for women, male sex, modifiable: diabetes mellitus, hypertension, hyperlipidemia, tobacco use) were analyzed. Analyses were stratified by non-ST-segment elevation MI (NSTEMI) versus ST-segment elevation MI (STEMI). The proportion of patients with ≥3 of 6 traditional risk factors slightly decreased over time in the NSTEMI (69.5%-66.8%, P < .0001) and STEMI (68.9%-66.4%, P < .0001) cohorts. The proportion of patients with ≥2 of 4 modifiable risk factors increased from 52% to 59% and then declined to 52.1% (P < .0001) in the NSTEMI cohort but declined slightly in the STEMI cohort (50.9%-47.3%, P < .0001). After adjusting for age and gender, the time trend of proportion with diabetes mellitus, hypertension, and tobacco use declined in both cohorts. However, the proportion of patients with hyperlipidemia remained similar. Although risk factor profiles in patients presenting with first MI have shown improvements over time, the changes are modest.American heart journal 04/2014; 167(4):480-488.e1. DOI:10.1016/j.ahj.2013.12.019 · 4.56 Impact Factor