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Trends in type 2 diabetes detection among adults in the USA, 1999–2014
  1. Linda S Geiss1,
  2. Kai McKeever Bullard1,
  3. Ralph Brinks2,
  4. Annika Hoyer2,
  5. Edward W Gregg1
  1. 1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Institute for Biometry and Epidemiology, German Diabetes Center, Dusseldorf, Germany
  1. Correspondence to Dr Kai McKeever Bullard; hjo1{at}


Objective To examine recent trends in type 2 diabetes detection among adults in the USA.

Research design and methods We used data from the 1999–2014 National Health and Nutrition Examination Surveys on non-pregnant adults (aged ≥18 years) not reporting a diagnosis of diabetes (n=16 644 participants, averaging about 2000 for each 2-year cycle). We defined undiagnosed diabetes as a fasting plasma glucose ≥126 mg/dL or a hemoglobin A1c ≥6.5% (48 mmol/mol). We measured case detection as the probability of finding undiagnosed type 2 diabetes among the population without diagnosed diabetes. Linear regression models were used to examine trends overall and by sociodemographic characteristics (ie, age, gender, race/ethnicity, education, poverty-income ratio (PIR)).

Results Age-standardized probability of finding undiagnosed type 2 diabetes was 3.0% (95% CI 2.1% to 4.2%) during 1999–2000 and 2.8% (2.2%–3.6%) during 2013–2014 (P for trend=0.52). Probability increased among Mexican-Americans (P for trend=0.01) but decreased among adults aged 65 years or older (P for trend=0.04), non-Hispanic (NH) white (P for trend=0.02), and adults in the highest PIR tertile (P for trend=0.047). For all other sociodemographic groups, no significant trends were detected.

Conclusions We found little evidence of increased detection of undiagnosed type 2 diabetes among adults in the USA during the past 15 years. Although improvements were seen among NH white, older, and wealthy adults, these improvements were not large. As the scope of primary prevention efforts increases, case detection may improve.

  • type 2 diabetes
  • epidemiology
  • diagnosis
  • survey research

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  • Contributors LSG participated in the study design, and drafted and revised the manuscript. KMB acquired and analysed the data, contributed to study design and critically reviewed the paper. RB, AH, EWG participated in the concept and design of the manuscript, critically reviewed and edited the manuscript, and contributed to the discussion. All authors approved the final version. LSG and KMB are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Not relevant as all data for this research were freely downloaded from the NCHS NHANES website at

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