Table 5.
Trends in diabetic renal disease markers in U.S. adults aged ≥ 18 years by glycemic status, NHANES 1988 to 2014
| 1988–1994 | 1999–2004 | 2005–2010 | 2011–2014 | Δ from 88–94 to 11–14 |
P interaction | |
|---|---|---|---|---|---|---|
| n=8007 | n=6640 | n=7861 | n=5463 | P trend | ||
| Any CKD | 0.038 | |||||
| Diagnosed diabetes | 30.3 (26.2–34.7) | 31.8 (29.0–34.7) | 29.6 (27.1–32.1) | 29.6 (26.2–33.3) | −0.7 (−6.0, 4.6) | 0.612 |
| Undiagnosed diabetes | 22.1 (18.1–26.7) | 31.1 (23.9–39.2) | 19.9 (15.9–24.7) | 20.4 (13.8–29.2) | −1.7 (−10.3, 6.9) | 0.283 |
| Prediabetes | 12.4 (10.6–14.4) | 13.1 (11.4–15.1) | 12.4 (10.9–14.2) | 11.4 (9.9–13.1) | −1.0 (−3.4, 1.4) | 0.353 |
| Normal glycemic status | 7.0 (5.9–8.2) | 9.4 (8.4–10.6) | 9.2 (7.9–10.7) | 10.4 (8.7–12.4) | +3.4 (1.2, 5.6) | 0.002 |
| ACR≥=30 | 0.001 | |||||
| Diagnosed diabetes | 29.9 (26.3–33.8) | 27.1 (24.4–30.0) | 24.5 (22.3–26.8) | 23.8 (20.7–27.3) | −6.1 (−10.8, −1.4) | 0.005 |
| Undiagnosed diabetes | 16.5 (13.0–20.6) | 25.3 (18.5–33.6) | 16.7 (13.3–20.7) | 17.5 (11.3–25.9) | 1.0 (−7.0, 9.0) | 0.729 |
| Prediabetes | 9.3 (7.7–11.2) | 9.1 (7.8–10.6) | 8.9 (7.7–10.3) | 7.7 (6.8–8.8) | −1.6 (−3.6, 0.4) | 0.118 |
| Normal glycemic status | 5.2 (4.4–6.2) | 6.2 (5.3–7.3) | 6.4 (5.3–7.6) | 7.5 (6.1–9.3) | +2.3 (0.5, 4.1) | 0.010 |
| Median ACR | ** | |||||
| Diagnosed diabetes | 22.0 (16.4–27.6) | 18.9 (14.2–23.6) | 19.6 (15.2–24.1) | 18.5 (15.8–21.2) | −3.5 (−6.3, −0.6) | 0.015 |
| Undiagnosed diabetes | 14.0 (6.1–20.0) | 18.1 (10.2–27.1) | 16.8 (9.0–22.7) | 16.6 (11.8–19.9) | 2.6 (−0.1, 5.7) | ** |
| Prediabetes | 10.4 (9.3–11.4) | 10.6 (9.5–11.6) | 10.6 (9.6–11.6) | 11.0 (10.4–11.7) | 0.7 (0.3, 1.1) | 0.004 |
| Normal glycemic status | 10.0 (9.0–11.0) | 9.7 (8.7–10.7) | 10.0 (9.1–11.0) | 10.7 (10.0–11.4) | 0.7 (0.4, 0.9) | <0.001 |
| eGFR<60 | 0.002 | |||||
| Diagnosed diabetes | 7.7 (5.9–9.9) | 9.5 (8.2–10.9) | 10.2 (8.9–11.6) | 11.8 (10.4–13.3) | +4.1 (1.7, 6.5) | 0.002 |
| Undiagnosed diabetes | 7.1 (5.1–9.9) | 8.0 (5.8–10.8) | 6.2 (4.7–8.1) | 6.8 (4.3–10.4) | −0.4 (−4.1, 3.3) | 0.622 |
| Prediabetes | 4.7 (3.9–5.5) | 5.7 (4.7–6.9) | 5.0 (4.3–5.9) | 4.6 (3.7–5.9) | 0.0 (−1.4, 1.4) | 0.769 |
| Normal glycemic status | 2.2 (1.8–2.8) | 5.1 (4.2–6.2) | 4.3 (3.4–5.3) | 3.8 (2.8–5.0) | +1.5 (0.3, 2.7) | 0.013 |
| Mean eGFR | <0.001 | |||||
| Diagnosed diabetes | 96.1 (93.7–98.4) | 92 (90.6–93.3) | 92.0 (90.5–93.5) | 90.4 (88.4–92.5) | −5.7 (−8.8, −2.6) | 0.001 |
| Undiagnosed diabetes | 97.0 (94.0–100.0) | 98.1 (94.6–101.5) | 96.0 (93.3–98.7) | 102 (96.9–107.2) | 5.0 (−0.9, 10.9) | 0.162 |
| Prediabetes | 96.1 (94.5–97.7) | 91.4 (90.1–92.7) | 94.4 (93.5–95.4) | 94.0 (92.4–95.6) | −2.1 (−4.3, 0.1) | 0.335 |
| Normal glycemic status | 99.4 (97.9–100.9) | 92.3 (91.2–93.3) | 94.8 (93.8–95.8) | 94.7 (93.3–96.1) | −4.7 (−6.8, −2.6) | <0.001 |
| Hyperfiltration | 0.269 | |||||
| Diagnosed diabetes | 13.6 (8.9–20.3) | 5.8 (4.4–7.7) | 7.6 (5.9–9.8) | 7.2 (5.3–9.7) | −6.4 (−12.5, −0.3) | 0.042 |
| Undiagnosed diabetes | 7.3 (3.5–14.4) | 14.5 (8.9–22.8) | 8.2 (5.4–12.3) | 12.0 (6.5–21.1) | 4.7 (−4.0, 13.4) | 0.523 |
| Prediabetes | 5.2 (3.9–6.9) | 3.3 (2.4–4.4) | 3.8 (3.0–4.8) | 4.3 (3.2–5.7) | −0.9 (−2.9, 1.1) | 0.500 |
| Normal glycemic status | 6.1 (4.9–7.5) | 3.8 (3.2–4.6) | 4.5 (3.8–5.2) | 4.4 (3.7–5.3) | −1.7 (−3.1, −0.3) | 0.068 |
NHANES, National Health and Nutrition Examinations Surveys; yr, year; FPG, fasting plasma glucose; ACR, albumin-creatinine ratio; eGFR, estimated glomerular filtration rate
Any CKD refers to either of: urine ACR>=30 and/or eGFR<60
Hyperfiltration defined as GFR>=135 ml/min/1.73m2
All analyses adjusted for age, sex, and race/ethnicity
P for trend: Calculated for each glycemic status group by including a continuous variable for the midpoint of each survey period in logistic regression models; significant values indicated variation over time within glycemic groups
P for interaction: significant P-values indicated varying associations between prevalence estimates over time across glycemic groups
Relative standard error >30% indicates that estimate may be unreliable