OBJECTIVE Confirmatory testing is recommended for diabetes diagnosis in clinical practice. However, national estimates of undiagnosed diabetes are based on single elevated test measures, potentially resulting in overestimation. Our objective was to update trends in undiagnosed diabetes using definitions consistent with clinical practice. RESEARCH DESIGN AND METHODS We included 30,492 adults (aged ≥20 years) from the National Health and Nutrition Examination Survey (1988–2020). Among adults without diagnosed diabetes, confirmed undiagnosed diabetes was defined as having both elevated levels of fasting plasma glucose (FPG) (≥126 mg/dL) and elevated glycated hemoglobin (HbA1c; ≥6.5%), and persistent undiagnosed diabetes was defined as having elevated HbA1c or FPG levels, adjusted for the within-person variability in HbA1c and FPG tests. RESULTS From the periods 1988–1994 to 2017 to March 2020, there was an increase in the prevalence of diagnosed diabetes (from 4.6 to 11.7%), but no change in prevalence of persistent undiagnosed diabetes (from 2.23 to 2.53%) or confirmed undiagnosed diabetes (from 1.10 to 1.23%). Consequently, the proportion of all undiagnosed diabetes cases declined from 32.8 to 17.8% (persistent undiagnosed diabetes) and from 19.3 to 9.5% (confirmed undiagnosed diabetes). Undiagnosed diabetes was more prevalent in older and obese adults, racial/ethnic minorities, and those without health care access. Among persons with diabetes, Asian Americans and those without health care access had the highest proportion of undiagnosed cases, with rates ranging from 23 to 61%. CONCLUSIONS From 1988 to March 2020, the proportion of undiagnosed diabetes cases declined substantially, suggesting major improvements in diabetes screening and detection. Undiagnosed diabetes currently affects 1–2% of US adults; up to 90% of all cases are diagnosed.

中文翻译：

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美国成人未确诊糖尿病：患病率和趋势


目的 建议在临床实践中对糖尿病进行验证性检测。然而，全国对未确诊糖尿病的估计是基于单一升高的测试指标，可能导致高估。我们的目标是使用与临床实践一致的定义来更新未确诊糖尿病的趋势。研究设计和方法 我们纳入了国家健康和营养检查调查（1988-2020 年）中的 30,492 名成年人（年龄≥20 岁）。在未诊断出糖尿病的成年人中，确诊的未诊断糖尿病被定义为空腹血糖 (FPG) (≥126 mg/dL) 水平升高且糖化血红蛋白 (HbA1c；≥6.5%) 水平升高，持续性未诊断糖尿病被定义为具有HbA1c 或 FPG 水平升高，并根据 HbA1c 和 FPG 测试的人内差异进行调整。结果 从1988-1994年到2017年至2020年3月，确诊糖尿病的患病率有所增加（从4.6%升至11.7%），但持续性未确诊糖尿病的患病率（从2.23%升至2.53%）或确诊未确诊糖尿病的患病率没有变化糖尿病（从 1.10% 降至 1.23%）。因此，所有未确诊糖尿病病例的比例从 32.8% 下降至 17.8%（持续性未确诊糖尿病），从 19.3% 下降至 9.5%（确诊未确诊糖尿病）。未确诊的糖尿病在老年人和肥胖成年人、少数种族/族裔以及无法获得医疗保健的人群中更为普遍。在糖尿病患者中，亚裔美国人和无法获得医疗保健的人未确诊病例的比例最高，比例为 23% 至 61%。结论 从 1988 年到 2020 年 3 月，未确诊糖尿病病例的比例大幅下降，表明糖尿病筛查和检测取得了重大进展。 目前，未确诊的糖尿病影响着 1-2% 的美国成年人；高达 90% 的病例得到诊断。