BACKGROUND: Although early recognition and treatment of diabetes may be essential to prevent complications, roughly one-fifth of diabetes remains undiagnosed. OBJECTIVE: Examine cardio-metabolic risk factors and their control in non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA) individuals with undiagnosed diabetes. DESIGN: Nationally representative cross-sectional study of participants in the National Health and Nutrition Examination Survey (NHANES) continuous cycles conducted 1999 through 2008. PARTICIPANTS: Of 22,621 non-pregnant individuals aged ≥20 years, 2521 had diagnosed diabetes. Of the remaining 20,100 individuals, 17,963 had HbA1c measured, 551 of whom were classified as having undiagnosed diabetes and comprise the study population. MAIN MEASURES: Undiagnosed diabetes was defined as HbA1c ≥ 6.5% without a self-report of physician diagnosed diabetes. Cardio-metabolic risk factor control was examined using regression methods for complex survey data. KEY RESULTS: Among individuals with undiagnosed diabetes, mean HbA1c level was 7.7% (95% CI: 7.5, 7.9), 19.3% (95% CI: 14.2, 24.3) smoked, 59.7% (95% CI: 54.5, 64.8%) had hypertension and 96.5% (95% CI: 94.6, 98.4%) had dyslipidemia. Lipid profiles were remarkably different across racial-ethnic groups: NHB had the highest LDL- and HDL-cholesterol, but the lowest triglycerides, while MA had the highest triglycerides and the lowest LDL-cholesterol. After adjusting for age, sex, NHANES examination cycle and use of either blood pressure or lipid medication, the odds of having blood pressure ≥130/80 mmHg was higher in NHB [1.92 (95% CI: 1.09, 3.55)] than NHW, while the odds of having LDL-cholesterol >100 mg/dl was higher in NHW[2.93 (95% CI: 1.37, 6.24)] and NHB[3.34 (95% CI: 1.08, 10.3)] than MA. CONCLUSIONS: In a nationally representative sample of individuals with undiagnosed diabetes, cardio-metabolic risk factor levels were high across all racial/ethnic groups, but NHB and MA had poorer control compared to NHW. Interventions that target identification of diabetes and treatment of cardio-metabolic risk factors are needed.
BACKGROUND: Although early recognition and treatment of diabetes may be essential to prevent complications, roughly one-fifth of diabetes remains undiagnosed. OBJECTIVE: Examine cardio-metabolic risk factors and their control in non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA) individuals with undiagnosed diabetes. DESIGN: Nationally representative cross-sectional study of participants in the National Health and Nutrition Examination Survey (NHANES) continuous cycles conducted 1999 through 2008. PARTICIPANTS: Of 22,621 non-pregnant individuals aged ≥20 years, 2521 had diagnosed diabetes. Of the remaining 20,100 individuals, 17,963 had HbA1c measured, 551 of whom were classified as having undiagnosed diabetes and comprise the study population. MAIN MEASURES: Undiagnosed diabetes was defined as HbA1c ≥ 6.5% without a self-report of physician diagnosed diabetes. Cardio-metabolic risk factor control was examined using regression methods for complex survey data. KEY RESULTS: Among individuals with undiagnosed diabetes, mean HbA1c level was 7.7% (95% CI: 7.5, 7.9), 19.3% (95% CI: 14.2, 24.3) smoked, 59.7% (95% CI: 54.5, 64.8%) had hypertension and 96.5% (95% CI: 94.6, 98.4%) had dyslipidemia. Lipid profiles were remarkably different across racial-ethnic groups: NHB had the highest LDL- and HDL-cholesterol, but the lowest triglycerides, while MA had the highest triglycerides and the lowest LDL-cholesterol. After adjusting for age, sex, NHANES examination cycle and use of either blood pressure or lipid medication, the odds of having blood pressure ≥130/80 mmHg was higher in NHB [1.92 (95% CI: 1.09, 3.55)] than NHW, while the odds of having LDL-cholesterol >100 mg/dl was higher in NHW[2.93 (95% CI: 1.37, 6.24)] and NHB[3.34 (95% CI: 1.08, 10.3)] than MA. CONCLUSIONS: In a nationally representative sample of individuals with undiagnosed diabetes, cardio-metabolic risk factor levels were high across all racial/ethnic groups, but NHB and MA had poorer control compared to NHW. Interventions that target identification of diabetes and treatment of cardio-metabolic risk factors are needed.
Authors: Catherine C Cowie; Keith F Rust; Danita D Byrd-Holt; Mark S Eberhardt; Katherine M Flegal; Michael M Engelgau; Sharon H Saydah; Desmond E Williams; Linda S Geiss; Edward W Gregg Journal: Diabetes Care Date: 2006-06 Impact factor: 19.112
Authors: David M Nathan; Patricia A Cleary; Jye-Yu C Backlund; Saul M Genuth; John M Lachin; Trevor J Orchard; Philip Raskin; Bernard Zinman Journal: N Engl J Med Date: 2005-12-22 Impact factor: 91.245
Authors: M I Harris; K M Flegal; C C Cowie; M S Eberhardt; D E Goldstein; R R Little; H M Wiedmeyer; D D Byrd-Holt Journal: Diabetes Care Date: 1998-04 Impact factor: 19.112
Authors: A Fagot-Campagna; K M Narayan; R L Hanson; G Imperatore; B V Howard; R G Nelson; D J Pettitt; W C Knowler Journal: Atherosclerosis Date: 1997-01-03 Impact factor: 5.162
Authors: Richelle J Koopman; Arch G Mainous; Heather A Liszka; John A Colwell; Elizabeth H Slate; Mark A Carnemolla; Charles J Everett Journal: Ann Fam Med Date: 2006 Sep-Oct Impact factor: 5.166
Authors: Carley A Gomez-Meade; Gabriela Lopez-Mitnik; Sarah E Messiah; Kristopher L Arheart; Adriana Carrillo; Nestor de la Cruz-Muñoz Journal: World J Diabetes Date: 2013-06-15
Authors: Cheryl R Clark; Mark J Ommerborn; DeMarc A Hickson; Kya N Grooms; Mario Sims; Herman A Taylor; Michelle A Albert Journal: PLoS One Date: 2013-05-14 Impact factor: 3.240
Authors: Todd M Brown; Rikki M Tanner; April P Carson; Huifeng Yun; Robert S Rosenson; Michael E Farkouh; J Michael Woolley; Evan L Thacker; Stephen P Glasser; Monika M Safford; Paul Muntner Journal: Diabetes Care Date: 2013-05-01 Impact factor: 19.112