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Indicator Details: Percentage with Diabetes Awareness, Treatment, and Controla,b
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Year, Awareness
Year, Control
NHANES
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Stacked Bar Confidence Intervals
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Related Indicators
Prevalence of Diagnosed Diabetes Mellitus in Children and Adolescents
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Percentage with Diabetes Awareness, Treatment, and Controla,b
National Health and Nutrition Examination Survey
75.8% (CI 71.0-80.6) 77.8% (CI 72.0-83.7) 75.7% (CI 70.5-80.9) 79.7% (CI 72.9-85.2) 72.8% (CI 66.7-78.9) 74.2% (CI 70.0-78.4) 76.2% (CI 72.6-79.9) 77.0% (CI 72.4-81.5)
* Indicates that the result for this cell was suppressed because of imprecision due to a sample size that was too small or the standard error of the result being too large (>30% of the estimate).
95% confidence intervals, when available, are shown in parentheses.
a Awareness = % with self-reported diabetes diagnosis, among those who had abnormal hemoglobin A1C levels ≥ 6.5% or were treated with diabetes medications; treatment = % treated with diabetes medications, among those with abnormal hemoglobin A1C levels ≥ 6.5% or self-reported diabetes diagnosis; and glycemic control = % with glycemic control as defined by fasting glucose <100 mg/dl, <125 mg/dl, or <150 mg/dl, or had hemoglobin A1C < 6.5%, among those treated with diabetes medication.
b Missing data represent estimates that were suppressed due to a relative standard error of 30% or more.
Field/Data
About 73% to 80% of U.S. adults with diabetes were aware of their disease during 1999 to 2014. Throughout the 16 years, more than half were treated for diabetes with medication (over 60% with hemoglobin A1C levels ≥ 6.5%); and with time, the percentage significantly increased (p <0.001) to more than half of participants being treated with diabetes medication were controlled (over 50% with hemoglobin A1C <7%).
Chart Explanation: Of participants who had diabetes by either measured hemoglobin A1C or reported use of diabetes medications, 77.0% were aware of their condition during 2013-2014. Very little change was observed in awareness during 1999 to 2014. In recent years, 48.7% of participants who had diabetes by either measured fasting glucose or reported use of diabetes medications, were being treated for their condition with medications. Participants who were on diabetes medications had low proportions of normal fasting glucose levels (9.5% <100 mg/dl, compared with 30.0% <125 mg/dl and 54.8% <150 mg/dl) for participants not taking medication, indicating that glycemic control in these individuals may be generally poor. These participants receiving treatment had an average hemoglobin A1C level of 6.3%, with 48.7% below the currently recommended cutoff of 6.5%. Over time, the percent of participants being treated for their diabetes has significantly increased from 61.5% in 1999-2000 to 72.6% in 2013-2014 (p <0.001).
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 Measure
Prevalence of diabetes mellitus and glycemic control in the general population
Type of Data Source
Health Care System Data
Regional or National?
Non-institutionalized U.S. residents aged 12+ years (20+ for adults)
Numerator
Non-pregnant participants with completed surveys or fasting glucose levels who report having diabetes (or with elevated fasting glucose)
Denominator
Non-pregnant participants with completed surveys (or fasting glucose levels)
Primary Data Source Indicator
diq010: "Other than during pregnancy, have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes?" yes/no
Primary Indicator Method of Measurement
Questionnaire (interviewer-administered); ages 1+
Secondary (1) Variable
lbxglu: Fasting plasma glucose (subsample)
Secondary (1) Indicator Method of Measurement
Examination/Laboratory
rhd143, rhd141/rhd140, urxpreg: current pregnancy
Questionnaire (interviewer-administered) or exam (urine pregnancy status)
nhcode/rxddrgid: generic drug codes
Questionnaire (interviewer-administered), with recording of medications from Rx bottles
Frequency of Measurement (Primary)
Once (cross-sectional)
U.S. Region Covered by Primary Variable
Period Currently Available
Pending Data
Additional Data Items of Interest
Stage of CKD, stratification variables of interest (age, gender, race/ethnicity, BMI, hypertension by self-report)
Limitations of Indicator
Fasting plasma glucose only on a subsample of morning participants who were fasting; OGTT available for 2005-2014 only
Analytic Considerations
Appropriate 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
References and Sources:
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.
Foley RN, Murray AM, Li S, et al. Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol. 2005;16(2):489-95.
National Institute of Diabetes and Digestive and Kidney Diseases. USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, Bethesda, MD: National Institutes of Health; 2011.
https://www.usrds.org/reference.aspx
American Diabetes Association. Standards of medical care in diabetes—2010 (position statement). Diabetes Care . 2010;33 Suppl 1:S11-61.