Implications of Alternative Definitions of Prediabetes for Prevalence in U.S. Adults

RTI International, Atlanta Regional Office, Atlanta, Georgia, USA.
Diabetes care (Impact Factor: 8.42). 02/2011; 34(2):387-91. DOI: 10.2337/dc10-1314
Source: PubMed


To compare the prevalence of prediabetes using A1C, fasting plasma glucose (FPG), and oral glucose tolerance test (OGTT) criteria, and to examine the degree of agreement between the measures.
We used the 2005-2008 National Health and Nutrition Examination Surveys to classify 3,627 adults aged ≥ 18 years without diabetes according to their prediabetes status using A1C, FPG, and OGTT. We compared the prevalence of prediabetes according to different measures and used conditional probabilities to examine agreement between measures.
In 2005-2008, the crude prevalence of prediabetes in adults aged ≥ 18 years was 14.2% for A1C 5.7-6.4% (A1C5.7), 26.2% for FPG 100-125 mg/dL (IFG100), 7.0% for FPG 110-125 mg/dL (IFG110), and 13.7% for OGTT 140-199 mg/dL (IGT). Prediabetes prevalence varied by age, sex, and race/ethnicity, and there was considerable discordance between measures of prediabetes. Among those with IGT, 58.2, 23.4, and 32.3% had IFG100, IFG110, and A1C5.7, respectively, and 67.1% had the combination of either A1C5.7 or IFG100.
The prevalence of prediabetes varied by the indicator used to measure risk; there was considerable discordance between indicators and the characteristics of individuals with prediabetes. Programs to prevent diabetes may need to consider issues of equity, resources, need, and efficiency in targeting their efforts.

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    • "In general, our findings are consistent with prior U.S. estimates of prediabetes prevalence based on assessment of impaired fasting glucose, impaired glucose tolerance, and HbA1c, which range from 15 to 43% for adults ≥45 years of age (3). Our estimate that 33% of adults ≥65 years of age have prediabetes is higher than the 26% estimate from the 2005 to2008 National Health and Nutrition Examination Survey (NHANES) (3). Although both the HRS and the NHANES are population-based health surveys, the HRS includes a larger sample of middle-aged and older adults, which may partially explain the different estimates in these two samples. "
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    ABSTRACT: OBJECTIVE To describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes.RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis of 5,991 respondents ≥53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA1c) of 5.7-6.4%. Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA1c ≥6.5%) or normoglycemia (no diabetes history and HbA1c <5.7%).RESULTSTwenty-eight percent of respondents ≥53 years of age had prediabetes; 32% had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56% had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33% had upper-extremity limitations (pushing or pulling heavy objects and/or lifting >10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P < 0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio [OR], 1.48), the lower extremities (1.35), and the upper extremities (1.37) (all P < 0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (1.21, P < 0.05).CONCLUSIONS Comorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations.
    Diabetes care 06/2013; 36(10). DOI:10.2337/dc13-0412 · 8.42 Impact Factor
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    • "Few nationally representative studies of the U.S. population have compared prediabetes prevalence estimates defined by A1C and FPG (14,15), and NHANES serves as the national data source for the studies that are available. Only one other study estimated national trends in prediabetes prevalence. "
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    ABSTRACT: OBJECTIVE Using a nationally representative sample of the civilian noninstitutionalized U.S. population, we estimated prediabetes prevalence and its changes during 1999-2010.RESEARCH DESIGN AND METHODS Data were from 19,182 nonpregnant individuals aged ≥12 years who participated in the 1999-2010 National Health and Nutrition Examination Surveys. We defined prediabetes as hemoglobin A1c 5.7 to <6.5% (39 to <48 mmol/mol, A1C5.7) or fasting plasma glucose (FPG) 100 to <126 mg/dL (impaired fasting glucose [IFG]). We estimated the prevalence of prediabetes, A1C5.7, and IFG for 1999-2002, 2003-2006, and 2007-2010. We calculated estimates age-standardized to the 2000 U.S. census population and used logistic regression to compute estimates adjusted for age, sex, race/ethnicity, poverty-to-income ratio, and BMI. Participants with self-reported diabetes, A1C ≥6.5% (≥48 mmol/mol), or FPG ≥126 mg/dL were included.RESULTSAmong those aged ≥12 years, age-adjusted prediabetes prevalence increased from 27.4% (95% CI 25.1-29.7) in 1999-2002 to 34.1% (32.5-35.8) in 2007-2010. Among adults aged ≥18 years, the prevalence increased from 29.2% (26.8-31.8) to 36.2% (34.5-38.0). As single measures among individuals aged ≥12 years, A1C5.7 prevalence increased from 9.5% (8.4-10.8) to 17.8% (16.6-19.0), a relative increase of 87%, whereas IFG remained stable. These prevalence changes were similar among the total population, across subgroups, and after controlling for covariates.CONCLUSIONS During 1999-2010, U.S. prediabetes prevalence increased because of increases in A1C5.7. Continuous monitoring of prediabetes is needed to identify, quantify, and characterize the population of high-risk individuals targeted for ongoing diabetes primary prevention efforts.
    Diabetes care 04/2013; 36(8). DOI:10.2337/dc12-2563 · 8.42 Impact Factor
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    • "The prevalence of combined IFG−IGT was significantly higher in group aged 50−59 years compared to the others. The findings indicated that prevalence of prediabetes did not show age effect, consistent with other reports [18,19]. Our results can be explained by: i) 5−10% of people per year with prediabetes may progress to diabetes, with the same proportion converting back to normoglycaemia [20], and ii) people with prediabetes may postpone or completely avoid the onset of type 2 diabetes with three simple strategies including losing weight, increasing physical activity, and eating more healthfully [20]. "
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    ABSTRACT: Background Despite the increasing prevalence of type 2 diabetes in urban areas, relatively little has been known about its actual prevalence and its associations in rural areas, Vietnam. The purpose of this study was to evaluate the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), diabetes and their risk factors in a rural province, Vietnam. Methods A cross–sectional study with a representative sample was designed to estimate the hyperglycemia prevalence, using 75–g oral glucose tolerance test. Potential risk factors for hyperglycemia were analyzed using multinomial logistic regression, taken into account influences of socio–economic status, anthropometric measures, and lifestyle–related factors. Results The age and sex–adjusted prevalence rates (95% CI) of isolated IFG, isolated IGT, combined IFG–IGT, and diabetes were 8.7 (7.0–10.5), 4.3 (3.2−5.4), 1.6 (0.9−2.3), and 3.7% (2.7–4.7%), respectively. There were still 73% of diabetic subjects without knowing the condition. Blood pressure, family history of diabetes, obesity–related measures (waist circumference, waist–hip ratio, body fat percentage, and abdominal obesity) were the independent risk factors for hyperglycemia (IFG, IGT, and diabetes). Conclusions The prevalence of hyperglycemia in rural areas has not been as sharply increased as that reported in urban cities, Vietnam. Blood pressure and obesity–related measures were the most significant predictors for hyperglycemia level and they can be taken into account in building prognosis models to early detection of diabetes in rural Vietnamese populations.
    BMC Public Health 11/2012; 12(1):939. DOI:10.1186/1471-2458-12-939 · 2.26 Impact Factor
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