Impaired glucose metabolism is now the norm?

From JAMA, “Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012“:

Importance: Previous studies have shown increasing prevalence of diabetes in the United States. New US data are available to estimate prevalence of and trends in diabetes.

Objective: To estimate the recent prevalence and update US trends in total diabetes, diagnosed diabetes, and undiagnosed diabetes using National Health and Nutrition Examination Survey (NHANES) data.

Design, Setting, and Participants: Cross-sectional surveys conducted between 1988-1994 and 1999-2012 of nationally representative samples of the civilian, noninstitutionalized US population; 2781 adults from 2011-2012 were used to estimate recent prevalence and an additional 23 634 adults from 1988-2010 were used to estimate trends.

Main Outcomes and Measures: The prevalence of diabetes was defined using a previous diagnosis of diabetes or, if diabetes was not previously diagnosed, by (1) a hemoglobin A1c level of 6.5% or greater or a fasting plasma glucose (FPG) level of 126 mg/dL or greater (hemoglobin A1c or FPG definition) or (2) additionally including 2-hour plasma glucose (2-hour PG) level of 200 mg/dL or greater (hemoglobin A1c, FPG, or 2-hour PG definition). Prediabetes was defined as a hemoglobin A1c level of 5.7% to 6.4%, an FPG level of 100 mg/dL to 125 mg/dL, or a 2-hour PG level of 140 mg/dL to 199 mg/dL.

Researchers wanted to use the latest data to check the prevalence of diabetes in the US. They employed National Health and Nutrition Examination Survey (NHANES) data to do so. They defined someone as having diabetes if (1) they were already diagnosed with it, or (2) they had an HgA1c of at least 6.5% or a fasting blood glucose of at least 126 mg/dL, or (3) they has a 2-hour blood glucose level of 200 mg/dL. They defined prediabetes by having an HgA1c of 5.7% to 6.4%, a fasting blood glucose of at 100 to 125 mg/dL, or a 2-hour blood glucose level of 140 to 199 mg/dL. Those are all pretty standard.

Here we go. In 2011-2012, the unadjusted prevalence of diabetes was 14.3%, and the prevalence of prediabetes was 38%. That means that more than half of people in the US have diabetes or prediabetes. Let that sink in for a minute. The prevalence of diabetes among non-Hispanic blacks was 21.8%, among non-Hispanic Asians was 20.6%, and among Hispanics was 22.6%. Those are scary numbers.

Of those with diabetes, more than a third were undiagnosed. They had lab values indicative of diabetes, but no diagnosis. So they were really unlikely to be managed at all, let alone well.

The prevalence of diabetes increased overall, and among all subgroups, between 1988-1994 and 2011-2012.

I have argued in past posts that when something “affects” the vast majority of people, it’s likely normal and not a disease. That isn’t the case this time. We need to get a handle on this.


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