Table 2.
Trends in the age-standardized prevalence of confirmed and persistent undiagnosed diabetes, 1988–2020, by subgroup
| Confirmed undiagnosed diabetes* | Persistent undiagnosed diabetes† | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Prevalence (SE) | P for trend‡ | Proportion (SE) of undiagnosed diabetes cases | P for trend‡ | Prevalence (SE) | P for trend‡ | Proportion (SE) of undiagnosed diabetes cases | P for trend‡ | |||||||
| Period | 1988–2010 | 2011–2020 | 1988–2010 | 2011–2020 | 1988–2010 | 2011–2020 | 1988–2010 | 2011–2020 | ||||||
| Age group, years | ||||||||||||||
| 20–44 | 0.44 (0.08) | 0.76 (0.11) | 0.01 | 15.6 (2.6) | 20.7 (2.6) | 0.13 | 0.81 (0.12) | 1.12 (0.14) | 0.26 | 25.4 (3.4) | 27.8 (3.2) | 0.92 | ||
| 45–64 | 1.71 (0.20) | 1.67 (0.24) | 0.01 | 15.0 (1.6) | 11.0 (1.5) | <0.001 | 2.88 (0.25) | 2.94 (0.27) | 0.17 | 22.9 (1.8) | 17.8 (1.7) | <0.001 | ||
| ≥65 | 2.49 (0.30) | 1.72 (0.38) | 0.52 | 13.4 (1.5) | 7.2 (1.5) | 0.01 | 5.32 (0.41) | 3.39 (0.38) | 0.16 | 24.9 (1.7) | 13.2 (1.4) | <0.001 | ||
| Sex | ||||||||||||||
| Female | 0.95 (0.10) | 1.33 (0.17) | 0.18 | 13.5 (2.1) | 14.7 (1.9) | 0.38 | 1.83 (0.15) | 2.13 (0.19) | 0.58 | 19.7 (1.5) | 18.3 (1.6) | 0.07 | ||
| Male | 1.73 (0.19) | 1.24 (0.23) | 0.05 | 16.4 (1.9) | 14.5 (2.4) | <0.001 | 3.22 (0.21) | 2.34 (0.24) | 0.04 | 28.3 (1.7) | 16.2 (1.5) | <0.001 | ||
| Race/ethnicity§ | ||||||||||||||
| Non-Hispanic White | 1.01 (0.13) | 0.86 (0.16) | 0.10 | 10.9 (1.7) | 8.5 (1.7) | <0.001 | 2.24 (0.16) | 1.69 (0.18) | 0.12 | 25.9 (1.7) | 15.7 (1.6) | <0.001 | ||
| Non-Hispanic Black | 2.26 (0.27) | 1.53 (0.31) | 0.14 | 15.8 (2.6) | 14.4 (2.8) | 0.01 | 3.64 (0.28) | 2.92 (0.35) | 0.02 | 22.8 (1.7) | 16.0 (1.7) | <0.001 | ||
| Mexican American | 2.61 (0.33) | 3.31 (0.50) | 0.28 | 24.8 (2.7) | 19.5 (3.0) | 0.07 | 3.30 (0.29) | 4.08 (0.48) | 0.46 | 18.9 (1.5) | 19.4 (2.0) | 0.13 | ||
| Asian American | –‖‖ | 2.59 (0.56) | – | – | 29.3 (5.5) | – | – | 4.03 (0.58) | – | – | 24.6 (3.0) | – | ||
| BMI category, kg/m2 | ||||||||||||||
| <25.0 | 0.33 (0.08) | 0.53 (0.16) | 0.35 | 8.0 (2.5) | 8.2 (2.7) | 0.87 | 1.11 (0.14) | 1.04 (0.19) | 0.42 | 21.6 (2.8) | 17.6 (3.2) | 0.10 | ||
| 25.0–29.9 | 1.07 (0.14) | 0.44 (0.08) | <0.001 | 15.9 (2.6) | 9.0 (2.8) | <0.001 | 2.09 (0.17) | 1.21 (0.16) | 0.004 | 26.3 (2.1) | 12.2 (1.6) | <0.001 | ||
| ≥30 | 2.47 (0.27) | 2.56 (0.31) | 0.45 | 15.5 (1.7) | 16.7 (1.7) | 0.01 | 4.15 (0.28) | 3.96 (0.32) | 0.28 | 23.7 (1.5) | 19.8 (1.5) | 0.002 | ||
| Education | ||||||||||||||
| College or more | 0.83 (0.19) | 0.54 (0.13) | 0.39 | 11.0 (2.6) | 12.4 (2.8) | 0.02 | 1.57 (0.23) | 1.50 (0.24) | 0.93 | 23.7 (3.2) | 16.5 (2.6) | 0.09 | ||
| Some college | 0.95 (0.16) | 1.57 (0.31) | 0.20 | 11.4 (1.9) | 15.4 (2.6) | 0.71 | 2.11 (0.24) | 2.05 (0.26) | 0.29 | 21.4 (2.2) | 15.7 (1.9) | 0.24 | ||
| High school or less | 1.76 (0.18) | 1.68 (0.22) | 0.68 | 18.1 (2.1) | 14.9 (2.1) | <0.001 | 3.13 (0.19) | 2.98 (0.25) | 0.41 | 25.5 (1.4) | 18.6 (1.4) | <0.001 | ||
| Income to poverty ratio, % | ||||||||||||||
| ≥350 | 0.91 (0.16) | 0.77 (0.17) | 0.59 | 12.2 (2.3) | 8.3 (1.9) | 0.002 | 1.85 (0.18) | 1.57 (0.22) | 0.61 | 26.0 (2.3) | 15.3 (2.2) | 0.002 | ||
| 130–349 | 1.58 (0.21) | 1.46 (0.21) | 0.94 | 16.1 (2.6) | 17.9 (2.4) | 0.02 | 2.91 (0.25) | 2.29 (0.25) | 0.29 | 24.0 (1.9) | 16.7 (1.7) | <0.001 | ||
| <130 | 1.65 (0.25) | 1.99 (0.35) | 0.78 | 13.8 (2.3) | 16.3 (2.4) | 0.16 | 2.80 (0.24) | 3.61 (0.37) | 0.71 | 20.7 (1.7) | 19.8 (1.9) | 0.17 | ||
| Health insurance coverage | ||||||||||||||
| Yes | 1.16 (0.11) | 1.13 (0.14) | 0.32 | 12.3 (1.4) | 11.7 (1.4) | <0.001 | 2.34 (0.14) | 2.09 (0.15) | 0.24 | 22.8 (1.3) | 16.1 (1.1) | <0.001 | ||
| No | 1.92 (0.34) | 2.09 (0.44) | 0.32 | 26.5 (4.1) | 24.1 (3.2) | 0.24 | 2.85 (0.39) | 3.86 (1.00) | 1.00 | 30.5 (4.1) | 28.8 (6.2) | 0.07 | ||
| Last health care visit, years | ||||||||||||||
| ≤1 | 1.17 (0.11) | 1.01 (0.11) | 0.34 | 10.9 (1.1) | 10.6 (1.2) | <0.001 | 2.44 (0.15) | 2.09 (0.13) | 0.20 | 22.1 (1.2) | 15.3 (1.0) | <0.001 | ||
| >1 | 2.08 (0.30) | 3.95 (1.03) | 0.23 | 57.5 (4.8) | 57.6 (5.6) | 0.03 | 2.71 (0.37) | 3.99 (0.82) | 0.35 | 54.8 (6.1) | 61.3 (6.6) | 0.02 | ||
| Usual source of care | ||||||||||||||
| Yes | 1.23 (0.11) | 1.19 (0.15) | 0.35 | 11.9 (1.2) | 12.1 (1.5) | <0.001 | 2.46 (0.14) | 2.17 (0.16) | 0.23 | 22.7 (1.2) | 16.1 (1.1) | <0.001 | ||
| No | 1.70 (0.41) | 2.02 (0.41) | 0.48 | 47.8 (5.9) | 33.4 (5.6) | 0.001 | 2.32 (0.39) | 2.49 (0.37) | 0.92 | 45.6 (6.6) | 31.3 (5.6) | <0.001 | ||
All estimates are age standardized with the 2017–2020 age distribution as the reference.
Confirmed undiagnosed diabetes was defined as having no diagnosed diabetes and an elevated HbA1c (≥6.5%) and FPG level (≥126 mg/dL).
Persistent undiagnosed diabetes was defined as having no diagnosed diabetes and an elevated HbA1c (≥6.5%) or FPG level (≥126 mg/dL) after adjusting for within-person variability in HbA1c and FPG measurement.
Based on logistic regression with the midpoint of each period modeled as a linear predictor.
Adults who self-reported other as their race/ethnicity were included in all analyses. However, we did not report race/ethnicity-specific estimates for this group since it likely combines participants from a variety of different racial/ethnic backgrounds.
Nationally representative data for Asian-American adults were unavailable in the NHANES until 2011.