title: Secular changes in U.S. Prediabetes prevalence defined by hemoglobin A1c and fasting plasma glucose: National Health and Nutrition Examination Surveys, 1999-2010.
abstract: OBJECTIVE
  Using a nationally representative sample of the civilian noninstitutionalized U.S. population, we estimated prediabetes prevalence and its changes during 1999-2010.
  
  
  METHODS
  Data were from 19,182 nonpregnant individuals aged ≥ 12 years who participated in the 1999-2010 National Health and Nutrition Examination Surveys. We defined prediabetes as hemoglobin A1c (A1C) 5.7 to <6.5% (39 to <48 mmol/mol, A1C5.7) or fasting plasma glucose (FPG) 100 to <126 mg/dL (impaired fasting glucose [IFG]). We estimated the prevalence of prediabetes, A1C5.7, and IFG for 1999-2002, 2003-2006, and 2007-2010. We calculated estimates age-standardized to the 2000 U.S. census population and used logistic regression to compute estimates adjusted for age, sex, race/ethnicity, poverty-to-income ratio, and BMI. Participants with self-reported diabetes, A1C ≥ 6.5% (≥ 48 mmol/mol), or FPG ≥126 mg/dL were included.
  
  
  RESULTS
  Among those aged ≥ 12 years, age-adjusted prediabetes prevalence increased from 27.4% (95% CI 25.1-29.7) in 1999-2002 to 34.1% (32.5-35.8) in 2007-2010. Among adults aged ≥ 18 years, the prevalence increased from 29.2% (26.8-31.8) to 36.2% (34.5-38.0). As single measures among individuals aged ≥ 12 years, A1C5.7 prevalence increased from 9.5% (8.4-10.8) to 17.8% (16.6-19.0), a relative increase of 87%, whereas IFG remained stable. These prevalence changes were similar among the total population, across subgroups, and after controlling for covariates.
  
  
  CONCLUSIONS
  During 1999-2010, U.S. prediabetes prevalence increased because of increases in A1C5.7. Continuous monitoring of prediabetes is needed to identify, quantify, and characterize the population of high-risk individuals targeted for ongoing diabetes primary prevention efforts.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. hjo1@cdc.gov
authors.forename: Kai McKeever
authors.initials: KM
authors.lastname: Bullard
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Saydah
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Cowie
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.forename: Yiling J
authors.initials: YJ
authors.lastname: Cheng
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Rolka
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Caspersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D044383:Black People / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000032:analysis*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011236:Prediabetic State / Q000453:epidemiology*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin