General information on diabetes in the United States

For release November 1, 1998

• CDC's Diabetes Translation Program
• New diagnostic criteria for diabetes
• Treatment of diabetes
• Impaired fasting glucose
• Appendix

Translates research findings into public health-oriented programs by

• Defining the nature, extent, distribution, and causes of the burden of diabetes
• Developing new approaches to reduce the diabetes burden that complement emerging health care systems
• Promoting the widespread application of standards, policies, and protocols to reduce the burden of diabetes by funding diabetes control programs in 50 states, 8 territories, and the District of Columbia
• Coordinating the diabetes-related efforts of the public health system with those of private health care providers, payers, managed-care organizations, and appropriate governmental, voluntary, professional, and academic institutions
• Implementing the public health components of the National Diabetes Education Program to improve treatment and outcomes for people with diabetes

The new diagnostic criteria for diabetes include the following changes:

• The routine diagnostic test for diabetes is now a fasting plasma glucose test rather than the previously preferred oral glucose tolerance test. (However, in certain clinical circumstances, physicians may still choose to perform the more difficult and costly oral glucose tolerance test.)
  
• A confirmed** fasting plasma glucose value of greater than or equal to 126 milligrams/deciliter (mg/dL) indicates a diagnosis of diabetes. Previously, a value of greater than or equal to 140 mg/dL had been required for diagnosis.
  
• In the presence of symptoms of diabetes, a confirmed** nonfasting plasma glucose value of greater than or equal to 200 mg/dL indicates a diagnosis of diabetes.
  
• When a doctor chooses to perform an oral glucose tolerance test (by administering 75 grams of anhydrous glucose dissolved in water, in accordance with World Health Organization standards, and then measuring the plasma glucose concentration 2 hours later), a confirmed** glucose value of greater than or equal to 200 mg/dL indicates a diagnosis of diabetes.

In pregnant women, different requirements are used to identify the presence of gestational diabetes.

* For further information about the new diagnostic criteria for diabetes, please refer to the "Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus," as referenced in the Appendix.

** Except in certain specified circumstances, abnormal tests must be confirmed by repeat testing on another day.

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Diabetes knowledge, treatment, and prevention strategies advance daily. Treatment is aimed at keeping blood glucose near normal levels at all times. Training in self- management is integral to the treatment of diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues.

• Treatment of type 1 diabetes: Lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections.
  
• Treatment of type 2 diabetes: Treatment typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40% of people with type 2 diabetes require insulin injections.

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Impaired fasting glucose is a new diagnostic category in which persons have fasting plasma glucose values of 110-125 mg/dL. These glucose values are greater than the level considered normal but less than the level that is diagnostic of diabetes. It is estimated that 13.4 million persons, 7.0% of the population, have impaired fasting glucose. Scientists are trying to learn how to predict which of these persons will go on to develop diabetes and how to prevent such progression.

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How were the estimates in this fact sheet derived?

Periodically, the federal government conducts surveys to determine the health of Americans. Such surveys involve questionnaires and medical tests. Most of the diabetes prevalence and incidence estimates presented in this fact sheet were developed by analyzing the newest available national survey data and then adjusting for changes in the population based on 1997 census estimates. The prevalence of diagnosed diabetes represents the number who said they had diabetes. The prevalence of undiagnosed diabetes represents the number of people who said they did not have diabetes, but when given a fasting plasma glucose test, they did in fact have abnormally elevated blood glucose levels (defined as fasting plasma glucose levels greater than or equal to 126 mg/dL). Other estimates presented in this fact sheet were based on individual surveys, research projects, and registry data. A listing of references and additional data sources is at the end of this fact sheet. Most of the national diabetes prevalence estimates are based on Harris MI, et al.

Has the number of persons with diabetes changed since the previous National Diabetes Fact Sheet, which was issued in 1995?

Between the 1995 and 1997 fact sheets, the number of persons with diagnosed diabetes increased from 8 million to 10.3 million, but the number of persons with undiagnosed diabetes decreased. For the 1995 National Diabetes Fact Sheet, the number of persons with undiagnosed diabetes was estimated from research using the oral glucose tolerance test to identify undiagnosed diabetes. In contrast, for the 1997 and 1998 National Diabetes Fact Sheets, the number of persons with undiagnosed diabetes was estimated from research using the fasting plasma glucose test, according to recently enacted recommendations. These tests are not equivalent, however, and fewer cases of undiagnosed diabetes are identified using the fasting plasma glucose test under current recommendations.

An enhanced national effort to identify previously undiagnosed persons may also have contributed to a decrease in the number of persons with undiagnosed diabetes. Continued efforts to identify persons with undiagnosed diabetes, the implementation of new guidelines for screening, and the use of an easier and less expensive diagnostic test are all likely to lead to even further decreases in the number of persons with undiagnosed diabetes and increases in the number of persons with diagnosed diabetes.

References

American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care 1998; 21(2): 296-309.

Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. Adults. Diabetes Care 1998; 21(4): 518-524.

National Diabetes Data Group, National Institutes of Health. Diabetes in America, 2nd Edition. Bethesda, MD: National Institutes of Health, 1995. NIH Publication No. 95-1468.

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997 July; 20(7):1183-97.

U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

U.S. Renal Data System. USRDS 1997 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1997.

Additional sources

Calcuations were performed by the National Institutes of Health and the Centers for Disease Control and Prevention using data from various surveys including the Third National Health and Nutrition Examination Survey (NHANES III, the National Health Interview Survey (NHIS), and U.S. Census estimates.

Information about American Indians and Alaska Natives was provided by Indian Health Service from its 1996 outpatient database. It does not include persons who receive their care outside Indian Health Service. Statistical analysis was performed by N. Rios Burrows.

Information about Native Hawaiians was provided by the Hawaii Diabetes Control Program and is based on Wen M, Unpublished Analysis of Data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1988-1995.

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