Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-29 (of 29 Records) |
Query Trace: Albright AL[original query] |
---|
Response to Comment on Cheng et al. Trends and Disparities in Cardiovascular Mortality Among U.S. Adults With and Without Self-Reported Diabetes, 1988-2015. Diabetes Care 2018;41:2306-2315
Cheng YJ , Imperatore G , Albright AL , Gregg EW . Diabetes Care 2019 42 (4) e63 We thank Manicardi et al. (1) for their insightful discussion of potential factors affecting our study of cardiovascular disease (CVD) mortality trends in the population with diabetes (2). Changes in diagnostic criteria and early detection of diabetes could indeed have affected the risk level and changes in rates of CVD differentially over time. We further agree that the population today is likely much different from that in the 1980s, perhaps due to the significant increases in obesity among the population with diabetes, which could influence risk as well. However, we caution that there is limited direct evidence that significant increases in detection have led to a healthier population or that the risk level at diagnosis has changed at a rate higher than the risk level of the underlying population (3). The impact of the 1997 change in diabetes definition and early detection of diabetes is also unknown but unlikely to explain the steady 12-year increase in incidence that occurred after that. Although we lack the appropriate data to quantify the impact of changing underlying risk directly, our indirect sensitivity analyses of these effects in the current report suggest that the impact of any lead-time bias on these trends was modest in comparison with the reductions that occurred (2). That said, the points raised by Manicardi et al. are important and underscore the need for more comprehensive epidemiologic data to understand the transitions underway in diabetes complications. |
Population-level approaches to preventing type 2 diabetes globally
Siegel KR , Albright AL . Endocrinol Metab Clin North Am 2021 50 (3) 401-414 Type 2 diabetes (T2DM) is increasingly considered an epidemic rooted in modern society as much as in individual behavior. Addressing the T2DM burden thus involves a dual approach, simultaneously addressing high-risk individuals and whole populations. Within this context, this article summarizes the evidence base, in terms of effectiveness and cost-effectiveness, for population-level approaches to prevent T2DM: (1) modifications to the food environment; (2) modifications to the built environment and physical activity; and (3) programs and policies to address social and economic factors. Existing knowledge gaps are also discussed. |
Long-term mortality among kidney transplant recipients with and without diabetes: a nationwide cohort study in the USA
Harding JL , Pavkov M , Wang Z , Benoit S , Burrows NR , Imperatore G , Albright AL , Patzer R . BMJ Open Diabetes Res Care 2021 9 (1) INTRODUCTION: Little is known about the role diabetes (type 1 (T1D) and type 2 (T2D)) plays in modifying prognosis among kidney transplant recipients. Here, we compare mortality among transplant recipients with T1D, T2D and non-diabetes-related end-stage kidney disease (ESKD). RESEARCH DESIGN AND METHODS: We included 254 188 first-time single kidney transplant recipients aged ≥18 years from the US Renal Data System (2000-2018). Diabetes status, as primary cause of ESKD, was defined using International Classification of Disease 9th and 10th Clinical Modification codes. Multivariable-adjusted Cox regression models (right-censored) computed risk of death associated with T1D and T2D relative to non-diabetes. Trends in standardized mortality ratios (SMRs) (2000-2017), relative to the general US population, were assessed using Joinpoint regression. RESULTS: A total of 72 175 (28.4%) deaths occurred over a median survival time of 14.6 years. 5-year survival probabilities were 88%, 85% and 77% for non-diabetes, T1D and T2D, respectively. In adjusted models, mortality was highest for T1D (HR=1.95, (95% CI: 1.88 to 2.03)) and then T2D (1.65 (1.62 to 1.69)), as compared with non-diabetes. SMRs declined for non-diabetes, T1D, and T2D. However, in 2017, SMRs were 2.38 (2.31 to 2.45), 6.55 (6.07 to 7.06), and 3.82 (3.68 to 3.98), for non-diabetes, T1D and T2D, respectively. CONCLUSIONS: In the USA, diabetes type is an important modifier in mortality risk among kidney transplant recipients with highest rates among people with T1D-related ESKD. Development of effective interventions that reduce excess mortality in transplant recipients with diabetes is needed, especially for T1D. |
Cost-effectiveness of interventions to manage diabetes: Has the evidence changed since 2008
Siegel KR , Ali MK , Zhou X , Ng BP , Jawanda S , Proia K , Zhang X , Gregg EW , Albright AL , Zhang P . Diabetes Care 2020 43 (7) 1557-1592 OBJECTIVE To synthesize updated evidence on the cost-effectiveness (CE) of interventions to manage diabetes, its complications, and comorbidities. RESEARCH DESIGN AND METHODS Weconducted a systematic literature review of studies from high-income countries evaluating the CE of diabetes management interventions recommended by the American Diabetes Association (ADA) and published in English between June 2008 and July 2017. We also incorporated studies from a previous CE review from the period 1985-2008. We classified the interventions based on their strength of evidence (strong, supportive, or uncertain) and levels of CE: Cost-saving (more health benefit at a lower cost), very cost-effective (£$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001-$50,000 per LYG or QALY), marginally cost-effective ($50,001-$100,000 per LYG or QALY), or not costeffective (>$100,000 per LYG or QALY). Costs were measured in 2017 U.S. dollars. RESULTS Seventy-three new studies met our inclusion criteria. These were combined with 49 studies from the previous review to yield 122 studies over the period 1985-2017. A large majority of the ADA-recommended interventions remain cost-effective. Specifically, we found strong evidence that the following ADA-recommended interventions are cost-saving or very cost-effective: In the cost-saving category are 1) ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy for intensive hypertension management compared with standard hypertension management, 2) ACEI/ARB therapy to prevent chronic kidney disease and/or end-stage renal disease in people with albuminuria compared with no ACEI/ARB therapy, 3) comprehensive foot care and patient education to prevent and treat foot ulcers among those at moderate/high risk of developing foot ulcers, 4) telemedicine for diabetic retinopathy screening compared with office screening, and 5) bariatric surgery compared with no surgery for individuals with type 2 diabetes (T2D) and obesity (BMI ‡30 kg/m2). In the very cost-effective category are 1) intensive glycemic management (targeting A1C <7%) compared with conventional glycemic management (targeting an A1C level of 8-10%) for individuals with newly diagnosed T2D, 2) multicomponent interventions (involving behavior change/education and pharmacological therapy targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, nephropathy/retinopathy, secondary prevention of cardiovascular disease with aspirin) compared with usual care, 3) statin therapy compared withnostatin therapy for individualswithT2Dandhistoryof cardiovascular disease,4) diabetes self-management education and support compared with usual care, 5) T2D screening every 3 years starting at age 45 years compared with no screening, 6) integrated, patient-centered care compared with usual care, 7) smoking cessation compared with no smoking cessation, 8) daily aspirin use as primary prevention for cardiovascular complications compared with usual care, 9) self-monitoring of blood glucose three times per day compared with once per day among those using insulin, 10) intensive glycemic management compared with conventional insulin therapy for T2D among adults aged ‡50 years, and 11) collaborative care for depression compared with usual care. CONCLUSIONS Complementing professional treatment recommendations, our systematic review provides an updated understanding of the potential value of interventions to manage diabetes and its complications and can assist clinicians and payers in prioritizing interventions and health care resources. |
Cost-effectiveness of diabetes prevention interventions targeting high-risk individuals and whole populations: A systematic review
Zhou X , Siegel KR , Ng BP , Jawanda S , Proia KK , Zhang X , Albright AL , Zhang P . Diabetes Care 2020 43 (7) 1593-1616 OBJECTIVE Weconducted a systematic review of studies evaluating the cost-effectiveness (CE) of interventions to prevent type 2 diabetes (T2D) among high-risk individuals and whole populations. RESEARCH DESIGN AND METHODS Interventions targeting high-risk individuals are those that identify people at high risk of developing T2D and then treat them with either lifestyle or metformin interventions. Population-based prevention strategies are those that focus on the whole population regardless of the level of risk, creating public health impact through policy implementation, campaigns, and other environmental strategies. We systematically searched seven electronic databases for studies published in English between 2008 and 2017. We grouped lifestyle interventions targeting highrisk individuals by delivery method and personnel type. We used the median incremental cost-effectiveness ratio (ICER), measured in cost per quality-adjusted life year (QALY) or cost saved to measure the CE of interventions. We used the $50,000/QALY threshold to determine whether an intervention was cost-effective or not. ICERs are reported in 2017 U.S. dollars. RESULTS Our review included 39 studies: 28 on interventions targeting high-risk individuals and 11 targeting whole populations. Both lifestyle and metformin interventions in high-risk individuals were cost-effective from a health care system or a societal perspective, with median ICERs of $12,510/QALY and $17,089/QALY, respectively, compared with no intervention. Among lifestyle interventions, those that followed a Diabetes Prevention Program (DPP) curriculum had a median ICER of $6,212/QALY, while those that did not follow a DPP curriculum had a median ICER of $13,228/QALY. Compared with lifestyle interventions delivered one-on-one or by a health professional, those offered in a group setting or provided by a combination of health professionals and lay health workers had lower ICERs. Among populationbased interventions, taxing sugar-sweetened beverages was cost-saving from both the health care system and governmental perspectives. Evaluations of other population-based interventionsdincluding fruit and vegetable subsidies, community-based education programs, and modifications to the built environmentd showed inconsistent results. CONCLUSIONS Most of the T2D prevention interventions included in our review were found to be either cost-effective or cost-saving. Our findings may help decision makers set priorities and allocate resources for T2D prevention in real-world settings. |
Sustained lower incidence of diabetes-related end-stage kidney disease among American Indians and Alaska Natives, Blacks, and Hispanics in the U.S., 2000-2016
Rios Burrows N , Zhang Y , Hora I , Pavkov ME , Sheff K , Imperatore G , Bullock AK , Albright AL . Diabetes Care 2020 43 (9) 2090-2097 OBJECTIVE: Diabetes-related end-stage kidney disease (ESKD-D) disproportionately affects U.S. racial/ethnic minority populations compared with whites. However, from 1996 to 2013, ESKD-D incidence among American Indians and Alaska Natives (AIANs) and blacks declined. We assessed recent ESKD-D incidence data to determine whether trends by race/ethnicity have changed since 2013. RESEARCH DESIGN AND METHODS: U.S. Renal Data System data from 2000 to 2016 were used to determine the number of whites, blacks, AIANs, Asians, and Hispanics aged >/=18 years with newly treated ESKD-D (with diabetes listed as primary cause). Using census population estimates as denominators, annual ESKD-D incidence rates were calculated and age adjusted to the 2000 U.S. standard population. Joinpoint regression was used to analyze trends and estimate an average annual percent change (AAPC) in incidence rates. RESULTS: For adults overall, from 2000 to 2016, age-adjusted ESKD-D incidence rates decreased by 53% for AIANs (66.7-31.2 per 100,000, AAPC -4.5%, P < 0.001), by 33% for Hispanics (50.0-33.3, -2.1%, P < 0.001), and by 20% for blacks (56.2-44.7, -1.6%, P < 0.001). However, during the study period, age-adjusted ESKD-D incidence rates did not change significantly for Asians and increased by 10% for whites (15.4-17.0, 0.6%, P = 0.01). In 2016, ESKD-D incidence rates in AIANs, Hispanics, and blacks were approximately 2.0-2.5 times higher than whites. CONCLUSIONS: ESKD-D incidence declined for AIANs, Hispanics, and blacks and increased for whites. Continued efforts might be considered to reverse the trend in whites and sustain and lower ESKD-D incidence in the other populations. |
Trends in emergency department visits and inpatient admissions for hyperglycemic crises in adults with diabetes, United States 2006-2015
Benoit SR , Hora I , Pasquel FJ , Gregg EW , Albright AL , Imperatore G . Diabetes Care 2020 43 (5) 1057-1064 OBJECTIVE: To report U.S. national population-based rates and trends in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) among adults, in both the emergency department (ED) and inpatient setting. RESEARCH DESIGN AND METHODS: We analyzed data from 1 January 2006 through 30 September 2015 from the Nationwide Emergency Department Sample and National Inpatient Sample to characterize ED visits and inpatient admissions with DKA and HHS. We used corresponding year cross-sectional survey data from the National Health Interview Survey to estimate the number of adults >/=18 years with diagnosed diabetes to calculate population-based rates for DKA and HHS in both ED and inpatient settings. Linear trends from 2009 to 2015 were assessed using Joinpoint software. RESULTS: In 2014, there were a total of 184,255 and 27,532 events for DKA and HHS, respectively. The majority of DKA events occurred in young adults aged 18-44 years (61.7%) and in adults with type 1 diabetes (70.6%), while HHS events were more prominent in middle-aged adults 45-64 years (47.5%) and in adults with type 2 diabetes (88.1%). Approximately 40% of the hyperglycemic events were in lower-income populations. Overall, event rates for DKA significantly increased from 2009 to 2015 in both ED (annual percentage change [APC] 13.5%) and inpatient settings (APC 8.3%). A similar trend was seen for HHS (APC 16.5% in ED and 6.3% in inpatient). The increase was in all age groups and in both men and women. CONCLUSIONS: Causes of increased rates of hyperglycemic events are unknown. More detailed data are needed to investigate the etiology and determine prevention strategies. |
National survey of primary care physicians' knowledge, practices, and perceptions of prediabetes
Tseng E , Greer RC , O'Rourke P , Yeh HC , McGuire MM , Albright AL , Marsteller JA , Clark JM , Maruthur NM . J Gen Intern Med 2019 34 (11) 2475-2481 BACKGROUND: Despite strong evidence and national policy supporting type 2 diabetes prevention, little is known about type 2 diabetes prevention in the primary care setting. OBJECTIVE: Our objective was to assess primary care physicians' knowledge and practice regarding perceived barriers and potential interventions to improving management of prediabetes. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: Nationally representative random sample of US primary care physicians (PCPs) identified from the American Medical Association Physician Masterfile. MAIN MEASURES: We assessed PCP knowledge, practice behaviors, and perceptions related to prediabetes. We performed chi-square and Fisher's exact tests to evaluate the association between PCP characteristics and the main survey outcomes. KEY RESULTS: In total, 298 (33%) eligible participants returned the survey. PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes. Only 36% of PCPs refer patients to a diabetes prevention lifestyle change program as their initial management approach, while 43% discuss starting metformin for prediabetes. PCPs believed that barriers to type 2 diabetes prevention are both at the individual level (e.g., patients' lack of motivation) and at the system level (e.g., lack of weight loss resources). PCPs reported that increased access to and insurance coverage of type 2 diabetes prevention programs and coordination of referral of patients to these resources would facilitate type 2 diabetes preventive efforts. CONCLUSIONS: Addressing gaps in PCP knowledge may improve the identification and management of people with prediabetes, but system-level changes are necessary to support type 2 diabetes prevention in the primary care setting. |
New directions in incidence and prevalence of diagnosed diabetes in the USA
Benoit SR , Hora I , Albright AL , Gregg EW . BMJ Open Diabetes Res Care 2019 7 (1) e000657 Objective: To determine whether diabetes prevalence and incidence has remained flat or changed direction during the past 5 years. Research design and methods: We calculated annual prevalence and incidence of diagnosed diabetes (type 1 and type 2 combined) for civilian, non-institutionalized adults aged 18-79 years using annual, nationally representative cross-sectional survey data from the National Health Interview Survey from 1980 to 2017. Trends in rates by age group, sex, race/ethnicity, and education were calculated using annual percentage change (APC). Results: Overall, the prevalence of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, but increased significantly (APC 4.4%) from 1990 to 2009 to a peak of 8.2 per 100 adults (95% CI 7.8 to 8.6), and then plateaued through 2017. The incidence of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, but increased significantly (APC 4.8%) from 1990 to 2007 to 7.8 per 1000 adults (95% CI 6.7 to 9.0), and then decreased significantly (APC -3.1%) to 6.0 (95% CI 4.9 to 7.3) in 2017. The decrease in incidence appears to be driven by non-Hispanic whites with an APC of -5.1% (p=0.002) after 2008. Conclusions: After an almost 20-year increase in the national prevalence and incidence of diagnosed diabetes, an 8-year period of stable prevalence and a decrease in incidence has occurred. Causes of the plateauing and decrease are unclear but the overall burden of diabetes remains high and deserves continued monitoring and intervention. |
Reach and use of diabetes prevention services in the United States, 2016-2017
Ali MK , McKeever Bullard K , Imperatore G , Benoit SR , Rolka DB , Albright AL , Gregg EW . JAMA Netw Open 2019 2 (5) e193160 Importance: Coordinated efforts by national organizations in the United States to implement evidence-based lifestyle modification programs are under way to reduce type 2 diabetes (hereinafter referred to as diabetes) and cardiovascular risks. Objective: To provide a status report on the reach and use of diabetes prevention services nationally. Design, Setting, and Participants: This nationally representative, population-based cross-sectional analysis of 2016 and 2017 National Health Interview Survey data was conducted from August 3, 2017, through November 15, 2018. Nonpregnant, noninstitutionalized, civilian respondents 18 years or older at high risk for diabetes, defined as those with no self-reported diabetes diagnosis but with diagnosed prediabetes or an elevated American Diabetes Association (ADA) risk score (>5), were included in the analysis. Analyses were conducted for adults with (and in sensitivity analyses, for those without) elevated body mass index. Main Outcomes and Measures: Absolute numbers and proportions of adults at high risk with elevated body mass index receiving advice about diet, physical activity guidance, referral to weight loss programs, referral to diabetes prevention programs, or any of these, and those affirming engagement in each (or any) activity in the past year were estimated. To identify where gaps exist, a prevention continuum diagram plotted existing vs desired goal achievement. Variation in risk-reducing activities by age, sex, race/ethnicity, educational attainment, insurance status, history of gestational diabetes mellitus, hypertension, or body mass index was also examined. Results: This analysis included 50912 respondents (representing 223.0 million adults nationally) 18 years or older (mean [SE] age, 46.1 [0.2] years; 48.1% [0.3%] male) with complete data and no self-reported diabetes diagnosis by their health care professional. Of the represented population, 36.0% (80.0 million) had either a physician diagnosis of prediabetes (17.9 million), an elevated ADA risk score (73.3 million), or both (11.3 million). Among those with diagnosed prediabetes, 73.5% (95% CI, 71.6%-75.3%) reported receiving advice and/or referrals for diabetes risk reduction from their health care professional, and, of those, 35.0% (95% CI, 30.5%-39.8%) to 75.8% (95% CI, 73.2%-78.3%) reported engaging in the respective activity or program in the past year. Half of adults with elevated ADA risk scores but no diagnosed prediabetes (50.6%; 95% CI, 49.5%-51.8%) reported receiving risk-reduction advice and/or referral, of whom 33.5% (95% CI, 30.1%-37.0%) to 75.2% (95% CI, 73.4%-76.9%) reported engaging in activities and/or programs. Participation in diabetes prevention programs was exceedingly low. Advice from a health care professional, age range from 45 to 64 years, higher educational attainment, health insurance status, gestational diabetes mellitus, hypertension, and obesity were associated with higher engagement in risk-reducing activities and/or programs. Conclusions and Relevance: Among adults at high risk for diabetes, major gaps in receiving advice and/or referrals and engaging in diabetes risk-reduction activities and/or programs were noted. These results suggest that risk perception, health care professional referral and communication, and insurance coverage may be key levers to increase risk-reducing behaviors in US adults. These findings provide a benchmark from which to monitor future program availability and coverage, identification of prediabetes, and referral to and retention in programs. |
Making strides in type 2 diabetes prevention
Albright AL . Diabetes Spectr 2018 31 (4) 299-302 The prevalence of diagnosed diabetes in adults in the United States, currently at 23.1 million people, has tripled in the past two decades (1). In addition, an estimated 84 million adults have prediabetes, putting them at increased risk of type 2 diabetes, heart attack, and stroke; only 1 in 10 know they have it (2). If interventions to slow the increase in and ultimately reduce the number of new cases of diabetes are not widely implemented, projections estimate that one in three adults in the United States could have diabetes by 2050 (3). |
Trends and disparities in cardiovascular mortality among U.S. adults with and without self-reported diabetes mellitus, 1988-2015
Cheng YJ , Imperatore G , Geiss LS , Saydah SH , Albright AL , Ali MK , Gregg EW . Diabetes Care 2018 41 (11) 2306-2315 OBJECTIVE: Cardiovascular disease (CVD) mortality has declined substantially in the U.S. The aims of this study were to examine trends and demographic disparities in mortality due to CVD and CVD subtypes among adults with and without self-reported diabetes. RESEARCH DESIGN AND METHODS: We used the National Health Interview Survey (1985-2014) with mortality follow-up data through the end of 2015 to estimate nationally representative trends and disparities in major CVD, ischemic heart disease (IHD), stroke, heart failure, and arrhythmia mortality among adults >/=20 years of age by diabetes status. RESULTS: Over a mean follow-up period of 11.8 years from 1988 to 2015 of 677,051 adults, there were significant decreases in major CVD death (all P values <0.05) in adults with and without diabetes except adults 20-54 years of age. Among adults with diabetes, 10-year relative changes in mortality were significant for major CVD (-32.7% [95% CI -37.2, -27.9]), IHD (-40.3% [-44.7, -35.6]), and stroke (-29.2% [-40.0, -16.5]), but not heart failure (-0.5% [-20.7, 24.7]), and arrhythmia (-12.0% [-29.4, 77.5]); the absolute decrease of major CVD among adults with diabetes was higher than among adults without diabetes (P < 0.001). Men with diabetes had larger decreases in CVD death than women with diabetes (P < 0.001). CONCLUSIONS: Major CVD mortality in adults with diabetes has declined, especially in men. Large reductions were observed for IHD and stroke mortality, although heart failure and arrhythmia deaths did not change. All race and education groups benefitted to a similar degree, but significant gaps remained across groups. |
Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data
Gregg EW , Cheng YJ , Srinivasan M , Lin J , Geiss LS , Albright AL , Imperatore G . Lancet 2018 391 (10138) 2430-2440 BACKGROUND: Large reductions in diabetes complications have altered diabetes-related morbidity in the USA. It is unclear whether similar trends have occurred in causes of death. METHODS: Using data from the National Health Interview Survey Linked Mortality files from 1985 to 2015, we estimated age-specific death rates and proportional mortality from all causes, vascular causes, cancers, and non-vascular, non-cancer causes among US adults by diabetes status. FINDINGS: From 1988-94, to 2010-15, all-cause death rates declined by 20% every 10 years among US adults with diabetes (from 23.1 [95% CI 20.1-26.0] to 15.2 [14.6-15.8] per 1000 person-years), while death from vascular causes decreased 32% every 10 years (from 11.0 [9.2-12.2] to 5.2 [4.8-5.6] per 1000 person-years), deaths from cancers decreased 16% every 10 years (from 4.4 [3.2-5.5] to 3.0 [2.8-3.3] per 1000 person-years), and the rate of non-vascular, non-cancer deaths declined by 8% every 10 years (from 7.7 [6.3-9.2] to 7.1 [6.6-7.5]). Death rates also declined significantly among people without diagnosed diabetes for all four major mortality categories. However, the declines in death rates were significantly greater among people with diabetes for all-causes (pinteraction<0.0001), vascular causes (pinteraction=0.0214), and non-vascular, non-cancer causes (pinteration<0.0001), as differences in all-cause and vascular disease death between people with and without diabetes were reduced by about a half. Among people with diabetes, all-cause mortality rates declined most in men and adults aged 65-74 years of age, and there was no decline in death rates among adults aged 20-44 years. The different magnitude of changes in cause-specific mortality led to large changes in the proportional mortality. The proportion of total deaths among adults with diabetes from vascular causes declined from 47.8% (95% CI 38.9-58.8) in 1988-94 to 34.1% (31.4-37.1) in 2010-15; this decline was offset by large increases in the proportion of deaths from non-vascular, non-cancer causes, from 33.5% (26.7-42.1) to 46.5% (43.3-50.0). The proportion of deaths caused by cancer was relatively stable over time, ranging from 16% to 20%. INTERPRETATION: Declining rates of vascular disease mortality are leading to a diversification of forms of diabetes-related mortality with implications for clinical management, prevention, and disease monitoring. FUNDING: None. |
A national effort to prevent type 2 diabetes: Participant-level evaluation of CDC's National Diabetes Prevention Program
Ely EK , Gruss SM , Luman ET , Gregg EW , Ali MK , Nhim K , Rolka DB , Albright AL . Diabetes Care 2017 40 (10) 1331-1341 OBJECTIVE: To assess participant-level results from the first 4 years of implementation of the National Diabetes Prevention Program (National DPP), a national effort to prevent type 2 diabetes in those at risk through structured lifestyle change programs. RESEARCH DESIGN AND METHODS: Descriptive analysis was performed on data from 14,747 adults enrolled in year-long type 2 diabetes prevention programs during the period February 2012 through January 2016. Data on attendance, weight, and physical activity minutes were summarized and predictors of weight loss were examined using a mixed linear model. All analyses were performed using SAS 9.3. RESULTS: Participants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, 35.5% achieved the 5% weight loss goal (average weight loss 4.2%, median 3.1%). Participants reported a weekly average of 152 min of physical activity (median 128 min), with 41.8% meeting the physical activity goal of 150 min per week. For every additional session attended and every 30 min of activity reported, participants lost 0.3% of body weight (P < 0.0001). CONCLUSIONS: During the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally. |
Cardiometabolic risk factor changes observed in Diabetes Prevention Programs in US settings: a systematic review and meta-analysis
Mudaliar U , Zabetian A , Goodman M , Echouffo-Tcheugui JB , Albright AL , Gregg EW , Ali MK . PLoS Med 2016 13 (7) e1002095 BACKGROUND: The Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. METHODS AND FINDINGS: In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%-7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional). Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl). Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. CONCLUSIONS: DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective. |
Medicare's intensive behavioral therapy for obesity: an exploratory cost-effectiveness analysis
Hoerger TJ , Crouse WL , Zhuo X , Gregg EW , Albright AL , Zhang P . Am J Prev Med 2015 48 (4) 419-25 INTRODUCTION: Medicare coverage recently was expanded to include intensive behavioral therapy for obese individuals in primary care settings. PURPOSE: To examine the potential cost effectiveness of Medicare's intensive behavioral therapy for obesity, accounting for uncertainty in effectiveness and utilization. METHODS: A Markov simulation model of type 2 diabetes was used to estimate long-term health benefits and healthcare system costs of intensive behavioral therapy for obesity in the Medicare population without diabetes relative to an alternative of usual care. Cohort statistics were based on the 2005-2008 National Health and Nutrition Examination Survey. Model parameters were derived from the literature. Analyses were conducted in 2014 and reported in 2012 U.S. dollars. RESULTS: Based on assumptions for the maximal intervention effectiveness, intensive behavioral therapy is likely to be cost saving if costs per session equal the current reimbursement rate ($25.19) and will provide a cost-effectiveness ratio of $20,912 per quality-adjusted life-year if costs equal the rate for routine office visits. The intervention is less cost effective if it is less effective in primary care settings or if fewer intervention sessions are supplied by providers or used by participants. CONCLUSIONS: If the effectiveness of the intervention is similar to lifestyle interventions tested in other settings and costs per session equal the current reimbursement rate, intensive behavioral therapy for obesity offers good value. However, intervention effectiveness and the pattern of implementation and utilization strongly influence cost effectiveness. Given uncertainty regarding these factors, additional data might be collected to validate the modeling results. |
Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012
Geiss LS , Wang J , Cheng YJ , Thompson TJ , Barker L , Li Y , Albright AL , Gregg EW . JAMA 2014 312 (12) 1218-26 IMPORTANCE: Although the prevalence and incidence of diabetes have increased in the United States in recent decades, no studies have systematically examined long-term, national trends in the prevalence and incidence of diagnosed diabetes. OBJECTIVE: To examine long-term trends in the prevalence and incidence of diagnosed diabetes to determine whether there have been periods of acceleration or deceleration in rates. DESIGN, SETTING, AND PARTICIPANTS: We analyzed 1980-2012 data for 664,969 adults aged 20 to 79 years from the National Health Interview Survey (NHIS) to estimate incidence and prevalence rates for the overall civilian, noninstitutionalized, US population and by demographic subgroups (age group, sex, race/ethnicity, and educational level). MAIN OUTCOMES AND MEASURES: The annual percentage change (APC) in rates of the prevalence and incidence of diagnosed diabetes (type 1 and type 2 combined). RESULTS: The APC for age-adjusted prevalence and incidence of diagnosed diabetes did not change significantly during the 1980s (for prevalence, 0.2% [95% CI, -0.9% to 1.4%], P = .69; for incidence, -0.1% [95% CI, -2.5% to 2.4%], P = .93), but each increased sharply during 1990-2008 (for prevalence, 4.5% [95% CI, 4.1% to 4.9%], P < .001; for incidence, 4.7% [95% CI, 3.8% to 5.6%], P < .001) before leveling off with no significant change during 2008-2012 (for prevalence, 0.6% [95% CI, -1.9% to 3.0%], P = .64; for incidence, -5.4% [95% CI, -11.3% to 0.9%], P = .09). The prevalence per 100 persons was 3.5 (95% CI, 3.2 to 3.9) in 1990, 7.9 (95% CI, 7.4 to 8.3) in 2008, and 8.3 (95% CI, 7.9 to 8.7) in 2012. The incidence per 1000 persons was 3.2 (95% CI, 2.2 to 4.1) in 1990, 8.8 (95% CI, 7.4 to 10.3) in 2008, and 7.1 (95% CI, 6.1 to 8.2) in 2012. Trends in many demographic subpopulations were similar to these overall trends. However, incidence rates among non-Hispanic black and Hispanic adults continued to increase (for interaction, P = .03 for non-Hispanic black adults and P = .01 for Hispanic adults) at rates significantly greater than for non-Hispanic white adults. In addition, the rate of increase in prevalence was higher for adults who had a high school education or less compared with those who had more than a high school education (for interaction, P = .006 for <high school and P < .001 for high school). CONCLUSIONS AND RELEVANCE: Analyses of nationally representative data from 1980 to 2012 suggest a doubling of the incidence and prevalence of diabetes during 1990-2008, and a plateauing between 2008 and 2012. However, there appear to be continued increases in the prevalence or incidence of diabetes among subgroups, including non-Hispanic black and Hispanic subpopulations and those with a high school education or less. |
Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985-2011: a modelling study
Gregg EW , Zhuo X , Cheng YJ , Albright AL , Narayan KM , Thompson TJ . Lancet Diabetes Endocrinol 2014 2 (11) 867-74 ![]() BACKGROUND: Diabetes incidence has increased and mortality has decreased greatly in the USA, potentially leading to substantial changes in the lifetime risk of diabetes. We aimed to provide updated estimates for the lifetime risk of development of diabetes and to assess the effect of changes in incidence and mortality on lifetime risk and life-years lost to diabetes in the USA. METHODS: We incorporated data about diabetes incidence from the National Health Interview Survey, and linked data about mortality from 1985 to 2011 for 598 216 adults, into a Markov chain model to estimate remaining lifetime diabetes risk, years spent with and without diagnosed diabetes, and life-years lost due to diabetes in three cohorts: 1985-89, 1990-99, and 2000-11. Diabetes was determined by self-report and was classified as any diabetes, excluding gestational diabetes. We used logistic regression to estimate the incidence of diabetes and Poisson regression to estimate mortality. FINDINGS: On the basis of 2000-11 data, lifetime risk of diagnosed diabetes from age 20 years was 40.2% (95% CI 39.2-41.3) for men and 39.6% (38.6-40.5) for women, representing increases of 20 percentage points and 13 percentage points, respectively, since 1985-89. The highest lifetime risks were in Hispanic men and women, and non-Hispanic black women, for whom lifetime risk now exceeds 50%. The number of life-years lost to diabetes when diagnosed at age 40 years decreased from 7.7 years (95% CI 6.5-9.0) in 1990-99 to 5.8 years (4.6-7.1) in 2000-11 in men, and from 8.7 years (8.4-8.9) to 6.8 years (6.7-7.0) in women over the same period. Because of the increasing diabetes prevalence, the average number of years lost due to diabetes for the population as a whole increased by 46% in men and 44% in women. Years spent with diabetes increased by 156% in men and 70% in women. INTERPRETATION: Continued increases in the incidence of diagnosed diabetes combined with declining mortality have led to an acceleration of lifetime risk and more years spent with diabetes, but fewer years lost to the disease for the average individual with diabetes. These findings mean that there will be a continued need for health services and extensive costs to manage the disease, and emphasise the need for effective interventions to reduce incidence. FUNDING: None. |
Modeling the impact of prevention policies on future diabetes prevalence in the United States: 2010-2030
Gregg EW , Boyle JP , Thompson TJ , Barker LE , Albright AL , Williamson DF . Popul Health Metr 2013 11 (1) 18 BACKGROUND: Although diabetes is one of the most costly and rapidly increasing serious chronic diseases worldwide, the optimal mix of strategies to reduce diabetes prevalence has not been determined. METHODS: Using a dynamic model that incorporates national data on diabetes prevalence and incidence, migration, mortality rates, and intervention effectiveness, we project the effect of five hypothetical prevention policies on future US diabetes rates through 2030: 1) no diabetes prevention strategy; 2) a "high-risk" strategy, wherein adults with both impaired fasting glucose (IFG) (fasting plasma glucose of 100-124 mg/dl) and impaired glucose tolerance (IGT) (2-hour post-load glucose of 141-199 mg/dl) receive structured lifestyle intervention; 3) a "moderate-risk" strategy, wherein only adults with IFG are offered structured lifestyle intervention; 4) a "population-wide" strategy, in which the entire population is exposed to broad risk reduction policies; and 5) a "combined" strategy, involving both the moderate-risk and population-wide strategies. We assumed that the moderate- and high-risk strategies reduce the annual diabetes incidence rate in the targeted subpopulations by 12.5% through 2030 and that the population-wide approach would reduce the projected annual diabetes incidence rate by 2% in the entire US population. RESULTS: We project that by the year 2030, the combined strategy would prevent 4.6 million incident cases and 3.6 million prevalent cases, attenuating the increase in diabetes prevalence by 14%. The moderate-risk approach is projected to prevent 4.0 million incident cases, 3.1 million prevalent cases, attenuating the increase in prevalence by 12%. The high-risk and population approaches attenuate the projected prevalence increases by 5% and 3%, respectively. Even if the most effective strategy is implemented (the combined strategy), our projections indicate that the diabetes prevalence rate would increase by about 65% over the 23 years (i.e., from 12.9% in 2010 to 21.3% in 2030). CONCLUSIONS: While implementation of appropriate diabetes prevention strategies may slow the rate of increase of the prevalence of diabetes among US adults through 2030, the US diabetes prevalence rate is likely to increase dramatically over the next 20 years. Demand for health care services for people with diabetes complications and diabetes-related disability will continue to grow, and these services will need to be strengthened along with primary diabetes prevention efforts. |
Preventing type 2 diabetes in communities across the U.S.: the National Diabetes Prevention Program
Albright AL , Gregg EW . Am J Prev Med 2013 44 S346-51 There are as many as 79 million people in the U.S. with prediabetes, and their risk of developing type 2 diabetes is four to 12 times higher than it is for people with normal glucose tolerance. Although advances in diabetes treatment are still needed, there is a critical need to implement effective strategies to stem the current and projected growth in new cases of type 2 diabetes. RCTs and translation studies have demonstrated that type 2 diabetes can be prevented or delayed in those at high risk, through a structured lifestyle intervention that can be delivered cost effectively. In order to bring this compelling lifestyle intervention to communities across America, Congress authorized the CDC to establish and lead the National Diabetes Prevention Program. Several aspects of the etiology of type 2 diabetes suggest that strategies addressing both those at high risk and the general population are necessary to make a major impact on the diabetes epidemic. |
Implications of risk stratification for diabetes prevention: the case of hemoglobin a1c
Gregg EW , Geiss L , Zhang P , Zhuo X , Williamson DF , Albright AL . Am J Prev Med 2013 44 S375-80 Although glycated hemoglobin (HbA1c) has been widely recommended for the diagnosis of diabetes, considerable ambiguity remains about how HbA1c should be used to identify people with prediabetes or other high-risk states for preventive interventions. The current paper provides a synthesis of the epidemiologic basis and the health and economic implications of using various HbA1c-based risk-stratification approaches for diabetes prevention. HbA1c predicts diabetes and related outcomes across a wide range of HbA1c values. However, the authors estimate that, among U.S. adults, the top 15% of the nondiabetic HBA1c distribution (HbA1c of 5.7%-6.4%) accounts for 47% of diabetes cases over 5 years, and the top 30% (5.5%-6.4%) accounts for about 70% of cases. Although this clustering of eventual cases at the high end of the HbA1c risk distribution means that intervention resources will be more efficient when applied to the upper end of the distribution, no obvious threshold exists to prioritize people for preventive interventions. Thus, the choice of optimal thresholds is a tradeoff, wherein selecting a lower HbA1c cut-point will lead to a higher rate of eligibility and health benefits for more people, and a higher HbA1c cut-point will lead to fewer cases of diabetes prevented but greater "economic efficiency" in terms of diabetes cases prevented per intervention participant. Selection of optimal HbA1c thresholds also may change with the evolving science, as better evidence on the biologic effectiveness of lower-intensity interventions and effects of lifestyle interventions on additional outcomes could pave the way for a more comprehensive, tiered approach to risk stratification. |
Access to health care and control of ABCs of diabetes
Zhang X , Bullard KM , Gregg EW , Beckles GL , Williams DE , Barker LE , Albright AL , Imperatore G . Diabetes Care 2012 35 (7) 1566-71 OBJECTIVE: To examine the relationship between access to health care and diabetes control. RESEARCH DESIGN AND METHODS: Using data from the National Health and Nutrition Examination Survey, 1999-2008, we identified 1,221 U.S. adults (age 18-64 years) with self-reported diabetes. Access was measured by current health insurance coverage, number of times health care was received over the past year, and routine place to go for health care. Diabetes control measures included the proportion of people with A1C >9%, blood pressure ≥140/90 mmHg, and non-HDL cholesterol ≥130 mg/dL. RESULTS: An estimated 16.0% of known diabetic adults were uninsured. Diabetes control profiles were worse among uninsured than among insured persons (A1C >9% [34.1 vs. 16.5%, P = 0.002], blood pressure ≥140/90 mmHg [31.8 vs. 22.8%, P < 0.05], and non-HDL cholesterol ≥130 mg/dL [67.1 vs. 65.4%, P = 0.7]). Compared with insured persons, uninsured persons were more likely to have A1C >9% (multivariate-adjusted odds ratio 2.4 [95% CI 1.2-4.7]). Compared with those who reported four or more health care visits in the past year, those who reported no health care visits were more likely to have A1C >9% (5.5 [1.2-26.3]) and blood pressure ≥140/90 mmHg (1.9 [1.1-3.4]). CONCLUSIONS: In people with diabetes, lack of health care coverage is associated with poor glycemic control. In addition, low use of health care service is associated with poor glucose and blood pressure control. |
Aging, diabetes, and the public health system in the United States
Caspersen CJ , Thomas GD , Boseman LA , Beckles GL , Albright AL . Am J Public Health 2012 102 (8) 1482-97 Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for $64.8 billion (56%) of direct diabetes medical costs, $41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults. (Am J Public Health. Published online ahead of print June 14, 2012: e1-e16. doi:10.2105/AJPH.2011.300616). |
Prevalence of diagnosed arthritis and arthritis-attributable activity limitation among adults with and without diagnosed diabetes: United States, 2008-2010
Cheng YJ , Imperatore G , Caspersen CJ , Gregg EW , Albright AL , Helmick CG . Diabetes Care 2012 35 (8) 1686-91 OBJECTIVE: To estimate the prevalence of diagnosed arthritis among U.S. adults and the proportion of arthritis-attributable activity limitation (AAAL) among those with arthritis by diagnosed diabetes mellitus (DM) status. RESEARCH DESIGN AND METHODS: We estimated prevalences and their ratios using 2008-2010 U.S. National Health Interview Survey of noninstitutionalized U.S. adults aged ≥18 years. Respondents' arthritis and DM status were both based on whether they reported a diagnosis of these diseases. Other characteristics used for stratification or adjustment included age, sex, race/ethnicity, education level, BMI, and physical activity level. RESULTS: Among adults with DM, the unadjusted prevalences of arthritis and proportion of AAAL among adults with arthritis (national estimated cases in parentheses) were 48.1% (9.6 million) and 55.0% (5.3 million), respectively. After adjusting for other characteristics, the prevalence ratio of arthritis and of AAAL among arthritic adults with versus without DM (95% CI) were: 1.44 (1.35-1.52) and 1.21 (1.15-1.28), respectively. The prevalence of arthritis increased with age and BMI and was higher for women, non-Hispanic whites, and inactive adults compared with their counterparts both among adults with- and without DM (all P values < 0.05). Among adults with diagnosed DM and arthritis, the proportion of AAAL was associated with being obese, but was not significantly associated with age, sex, and race/ethnicity. CONCLUSION: Among U.S. adults with diagnosed DM, nearly half also have diagnosed arthritis; moreover, more than half of those with both diseases had AAAL. Arthritis can be a barrier to physical activity among adults with diagnosed DM. |
Access to health care and undiagnosed diabetes along the United States-Mexico border
Zhang X , Beckles GL , Bullard KM , Gregg EW , Albright AL , Barker L , Ruiz-Holguin R , Cerqueira MT , Frontini M , Imperatore G . Rev Panam Salud Publica 2010 28 (3) 182-9 OBJETIVE: To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. METHODS: Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3 470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. RESULTS: People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0-6.6, and OR 4.5, 95% CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% CI 11.5%-46.3%, versus 9.1%, 95% CI 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made > 4 visits (40.8%, 95% CI 19.6%-62.0%, and 23.4%, 95% CI 9.9%-36.9%, respectively, versus 2.4%, 95% CI -0.9%-5.7%) (all, P < 0.05). No similar pattern was found in Mexico. CONCLUSIONS: Limited access to health care-especially not having health insurance and/or not having a place to receive routine health services-was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region. |
Prevalence of diabetic retinopathy in the United States, 2005-2008
Zhang X , Saaddine JB , Chou CF , Cotch MF , Cheng YJ , Geiss LS , Gregg EW , Albright AL , Klein BE , Klein R . JAMA 2010 304 (6) 649-56 CONTEXT: The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists. OBJECTIVES: To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older. DESIGN, SETTING, AND PARTICIPANTS: Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. MAIN OUTCOME MEASUREMENTS: Diabetic retinopathy and vision-threatening diabetic retinopathy. RESULTS: The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). CONCLUSION: In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals. |
A1C level and future risk of diabetes: a systematic review
Zhang X , Gregg EW , Williamson DF , Barker LE , Thomas W , Bullard KM , Imperatore G , Williams DE , Albright AL . Diabetes Care 2010 33 (7) 1665-73 We examined ranges of A1C useful for identifying persons at high risk for diabetes prior to preventive intervention by conducting a systematic review. From 16 included studies, we found that annualized diabetes incidence ranged from 0.1% at A1C <5.0% to 54.1% at A1C >or=6.1%. Findings from 7 studies that examined incident diabetes across a broad range of A1C categories showed 1) risk of incident diabetes increased steeply with A1C across the range of 5.0 to 6.5%; 2) the A1C range of 6.0 to 6.5% was associated with a highly increased risk of incident diabetes, 25 to 50% incidence over 5 years; 3) the A1C range of 5.5 to 6.0% was associated with a moderately increased relative risk, 9 to 25% incidence over 5 years; and 4) the A1C range of 5.0 to 5.5% was associated with an increased incidence relative to those with A1C <5%, but the absolute incidence of diabetes was less than 9% over 5 years. Our systematic review demonstrated that A1C values between 5.5 and 6.5% were associated with a substantially increased risk for developing diabetes. |
Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the U.S. population: implications for diabetes diagnostic thresholds
Cheng YJ , Gregg EW , Geiss LS , Imperatore G , Williams DE , Zhang X , Albright AL , Cowie CC , Klein R , Saaddine JB . Diabetes Care 2009 32 (11) 2027-32 OBJECTIVE: To examine the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy in the U.S. population and to compare the ability of the two glycemic measures to discriminate between people with and without retinopathy. RESEARCH DESIGN AND METHODS: This study included 1,066 individuals aged >or=40 years from the 2005-2006 National Health and Nutrition Examination Survey. A1C, FPG, and 45 degrees color digital retinal images were assessed. Retinopathy was defined as a level >or=14 on the Early Treatment Diabetic Retinopathy Study severity scale. We used joinpoint regression to identify linear inflections of prevalence of retinopathy in the association between A1C and FPG. RESULTS: The overall prevalence of retinopathy was 11%, which is appreciably lower than the prevalence in people with diagnosed diabetes (36%). There was a sharp increase in retinopathy prevalence in those with A1C >or=5.5% or FPG >or=5.8 mmol/l. After excluding 144 people using hypoglycemic medication, the change points for the greatest increase in retinopathy prevalence were A1C 5.5% and FPG 7.0 mmol/l. The coefficients of variation were 15.6 for A1C and 28.8 for FPG. Based on the areas under the receiver operating characteristic curves, A1C was a stronger discriminator of retinopathy (0.71 [95% CI 0.66-0.76]) than FPG (0.65 [0.60 - 0.70], P for difference = 0.009). CONCLUSIONS: The steepest increase in retinopathy prevalence occurs among individuals with A1C >or=5.5% and FPG >or=5.8 mmol/l. A1C discriminates prevalence of retinopathy better than FPG. |
Three decade change in the prevalence of hearing impairment and its association with diabetes in the United States
Cheng YJ , Gregg EW , Saaddine JB , Imperatore G , Zhang X , Albright AL . Prev Med 2009 49 (5) 360-4 OBJECTIVE: to examine the secular change of the prevalence of hearing impairment over three decades in U.S. adults with and without diabetes. METHODS: the cross-sectional National Health and Nutrition Examination Surveys (NHANES, the 1971-1973 [NHANES I] and the 1999-2004 [NHANES 1999-2004]) were used. Average pure-tone audiometry thresholds in decibels (dB) at 1, 2, 3, 4 kHz frequencies of the worse ear were used to represent the participants' hearing status. Any hearing impairment was defined as average pure-tone audiometry threshold of the worse ear >25 dB. RESULTS: From 1971 to 2004, among adults without diabetes aged 25 to 69 years, the unadjusted prevalence of hearing impairment decreased from 27.9% to 19.1% (P <0.001), but among adults with diabetes there was no significant change (46.4% to 48.5%). After adjustment for age, sex, race, and education, the prevalence of hearing impairment in the NHANES I and NHANES 1999-2004, respectively, was 24.4% (95% confidence interval [CI], 22.3-26.6%) and 22.3% (95% CI, 20.4-24.2) for adults without diabetes and 28.5% (95% CI, 20.4-36.6%) and 34.4 (95% CI, 29.1-39.7%) for adults with diabetes. The adjusted prevalence ratios of hearing impairment for persons with diabetes vs. those without diabetes was 1.17 (95% CI, 0.87-1.57) for the NHANES I and 1.53 (95% CI, 1.28-1.83) for NHANES 1999-2004. CONCLUSIONS: Persons with diabetes have a higher prevalence of hearing impairment, and they have not achieved the same reductions in hearing impairment over time as have persons without diabetes. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Jan 27, 2025
- Content source:
- Powered by CDC PHGKB Infrastructure