A common belief is that one quarter to one third of all diabetes cases remain undiagnosed. However, such prevalence estimates may be overstated by epidemiologic studies that do not use confirmatory testing, as recommended by clinical diagnostic criteria.

To provide national estimates of undiagnosed diabetes by using a confirmatory testing strategy, in line with clinical practice guidelines.

Cross-sectional study.

National Health and Nutrition Examination Survey results from 1988 to 1994 and 1999 to 2014.

U.S. adults aged 20 years and older.

Confirmed undiagnosed diabetes was defined as elevated levels of fasting glucose (≥7.0 mmol/L [≥126 mg/dL]) and hemoglobin A_1c (≥6.5%) in persons without diagnosed diabetes.

The prevalence of total (diagnosed plus confirmed undiagnosed) diabetes increased from 5.5% (9.7 million adults) in 1988 to 1994 to 10.8% (25.5 million adults) in 2011 to 2014. Confirmed undiagnosed diabetes increased during the past 2 decades (from 0.89% in 1988 to 1994 to 1.2% in 2011 to 2014) but has decreased over time as a proportion of total diabetes cases. In 1988 to 1994, the percentage of total diabetes cases that were undiagnosed was 16.3%; by 2011 to 2014, this estimate had decreased to 10.9%. Undiagnosed diabetes was more common in overweight or obese adults, older adults, racial/ethnic minorities (including Asian Americans), and persons lacking health insurance or access to health care.

Cross-sectional design.

Establishing the burden of undiagnosed diabetes is critical to monitoring public health efforts related to screening and diagnosis. When a confirmatory definition is used, undiagnosed diabetes is a relatively small fraction of the total diabetes population; most U.S. adults with diabetes (about 90%) have received a diagnosis of the condition.

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and National Heart, Lung, and Blood Institute.

人们普遍认为，四分之一到三分之一的糖尿病病例仍未得到诊断。然而，根据临床诊断标准的建议，不使用验证性检测的流行病学研究可能会夸大这种流行率估计值。

根据临床实践指南，通过使用确认性测试策略提供未确诊糖尿病的全国估计值。

横断面研究。

1988年至1994年和1999年至2014年全国健康与营养调查结果。

20 岁及以上的美国成年人。

确诊的未确诊糖尿病定义为未确诊糖尿病患者的空腹血糖（≥7.0 mmol/L [≥126 mg/dL]）和血红蛋白 A _1c（≥6.5%）水平升高。

糖尿病总患病率（确诊加确诊未确诊）从 1988 年到 1994 年的 5.5%（970 万成年人）增加到 2011 年到 2014 年的 10.8%（2550 万成年人）。过去 20 年确诊的未确诊糖尿病增加（从 0.89% 1988 年至 1994 年降至 2011 年至 2014 年的 1.2%），但随着时间的推移在糖尿病总病例中的比例有所下降。1988 年至 1994 年，未确诊的糖尿病总病例百分比为 16.3%；到 2011 年至 2014 年，这一估计已降至 10.9%。未确诊的糖尿病在超重或肥胖的成年人、老年人、少数族裔（包括亚裔美国人）以及缺乏医疗保险或无法获得医疗保健的人中更为常见。

横截面设计。

确定未确诊糖尿病的负担对于监测与筛查和诊断相关的公共卫生工作至关重要。当使用确认性定义时，未确诊的糖尿病仅占糖尿病总人口的一小部分；大多数患有糖尿病的美国成年人（约 90%）都接受了该病的诊断。

美国国立卫生研究院、国家糖尿病、消化和肾脏疾病研究所和国家心肺血液研究所。