The National Diabetes Statistics Report, a periodic publication of the Centers for Disease Control and. Prevention (CDC), provides information on the
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This document is intended to provide up-to-date scientific data and statistics on diabetes and its burden in the United States. Formerly known as the National Diabetes Fact Sheet, this consensus document is written primarily for a scientific audience. Estimates of Diabetes and Its Burden in the United States National Diabetes Statistics Report 2020 CS 314227-A
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National Diabetes Statistics Report, 2020 iiCONTENTS Introduction .1Methods .1Results 2Prevalence of Diabetes (Diagnosed and Undiagnosed) ..2Prevalence of Diagnosed Diabetes 4Incidence of Diagnosed Diabetes (Newly Diagnosed Diabetes) .5Prevalence of Prediabetes Among Adults 8Risk Factors for Diabetes-Related Complications ..9Preventing Diabetes-Related Complications ..10Coexisting Conditions and Complications .11Acknowledgments 14References .14Suggested Citation ..14Appendix A: Detailed Tables 15Appendix B: Detailed Methods and Data Sources ..21
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National Diabetes Statistics Report, 2020 1INTRODUCTION The National Diabetes Statistics Report, a periodic publication of the Centers for Disease Control and Prevention (CDC), provides information on the prevalence and incidence of diabetes and prediabetes, risk factors for complications, acute and long-term complications, deaths, and costs. These data can help focus e˜orts to prevent and control diabetes across the United States. This document is an update of the 2017 National Diabetes Statistics Report and is intended for a scienti˚c audience. METHODS New in 2020, this National Diabetes Statistics Report features trends in prevalence and incidence estimates over time. The estimates in this document (unless otherwise noted) were derived from various data systems of CDC, Indian Health Service (IHS), Agency for Healthcare Research and Quality (AHRQ), and US Census Bureau, and from published research studies. Estimated percentages and total number of people with diabetes and prediabetes were derived from the National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), IHS National Data Warehouse (NDW), Behavioral Risk Factor Surveillance System (BRFSS), United States Diabetes Surveillance System (USDSS), and US resident population estimates. Diagnosed diabetes status was determined from self-reported information provided by survey respondents; for American Indians and Alaska Natives who accessed IHS or tribal health facilities that submitted medical records data to the IHS NDW, clinical diagnostic codes were also used. Undiagnosed diabetes was determined by measured fasting plasma glucose or A1C levels. Numbers and rates for acute and long-term complications of diabetes were derived from the National Inpatient Sample (NIS) and National Emergency Department Sample (NEDS), as well as NHIS. For some measures, estimates were not available for certain racial and ethnic subgroups due to small sample sizes. An alpha level of 0.05 was used when determining statistically signi˚cant di˜erences between groups. Age-adjusted estimates were calculated among adults aged 18 years or older by the direct method to the 2000 US Census standard population, using age groups 18Œ44, 45Œ64, and 65 years or older. Most estimates of diabetes in this report do not di˜erentiate between type 1 and type 2 diabetes. However, as type 2 diabetes accounts for 90% to 95% of all diabetes cases, the data presented here are more likely to be characteristic of type 2 diabetes, except as noted. More information about the data sources, methods, and references is available in the Detailed Methods and Data Sources section.
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National Diabetes Statistics Report, 2020 2RESULTS Prevalence of Diabetes (Diagnosed and Undiagnosed) (See Detailed Methods )Among the US population overall, crude estimates for 2018 were: Ł 34.2 million people of all agesŠor 10.5% of the US populationŠhad diabetes. Ł 34.1 million adults aged 18 years or olderŠor 13.0% of all US adultsŠhad diabetes (Table 1a; Table 1b). Ł 7.3 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes (undiagnosed diabetes, Table 1b). This number represents 2.8% of all US adults (Table 1a) and 21.4% of all US adults with diabetes. Ł The percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65 years or older (Table 1a). Table 1a. Estimated crude prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 2013Œ2016 Characteristic Diagnosed diabetes Percentage (95% CI)Undiagnosed diabetes Percentage (95% CI)Total diabetes Percentage (95% CI)Total 10.2 (9.3Œ11.2)2.8 (2.4Œ3.3)13.0 (12.0Œ14.1)Age in years 18Œ443.0 (2.6Œ3.6)1.1 (0.7Œ1.8)4.2 (3.4Œ5.0)45Œ6413.8 (12.2Œ15.6)3.6 (2.8Œ4.8)17.5 (15.7Œ19.4)˛6521.4 (18.7Œ24.2)5.4 (4.1Œ7.1)26.8 (23.7Œ30.1)Sex Men 11.0 (9.7Œ12.4)3.1 (2.3Œ4.2)14.0 (12.3Œ15.5)Women 9.5 (8.5Œ10.6)2.5 (2.0Œ3.2)12.0 (11.0Œ13.2)Race/ethnicity White, non-Hispanic 9.4 (8.4Œ10.5)2.5 (1.9Œ3.3)11.9 (10.9Œ13.0)Black, non-Hispanic 13.3 (11.9Œ14.9)3.0 (2.0Œ4.5)16.4 (14.7Œ18.2)Asian, non-Hispanic 11.2 (9.5Œ13.3)4.6 (2.8Œ7.2)14.9 (12.0Œ18.2)Hispanic 10.3 (8.1Œ13.1)3.5 (2.5Œ4.8)14.7 (12.5Œ17.3)Notes: CI = confidence interval. Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Numbers for subgroups may not add up to the total because of rounding. Age-adjusted estimates are presented in Appendix Table 1 .Data source: 2013Œ2016 National Health and Nutrition Examination Survey.
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National Diabetes Statistics Report, 2020 3Table 1b. Estimated number of adults aged 18 years or older with diagnosed diabetes, undiagnosed diabetes, and total diabetes, United States, 2018 Characteristic Diagnosed diabetes Number in Millions (95% CI)Undiagnosed diabetes Number in Millions (95% CI)Total diabetes Number in Millions (95% CI)Total 26.8 (24.4Œ29.1)7.3 (6.3Œ8.4)34.1 (31.6Œ36.6)Age in years 18Œ443.6 (3.0Œ4.1)1.4 (0.8Œ1.9)4.9 (4.0Œ5.8)45Œ6411.7 (10.3Œ13.1)3.1 (2.3Œ3.9)14.8 (13.4Œ16.3)˛6511.5 (10.1Œ12.8)2.9 (2.1Œ3.6)14.3 (12.7Œ15.9)Sex Men 14.0 (12.4Œ15.6)3.9 (2.8Œ5.0)17.9 (16.2Œ19.6)Women 12.8 (11.4Œ14.1)3.4 (2.7Œ4.1)16.2 (14.8Œ17.6)Race/ethnicity White, non-Hispanic 15.4 (13.8Œ17.0)4.1 (3.1Œ5.2)19.5 (17.9Œ21.2)Black, non-Hispanic 4.2 (3.8Œ4.7)0.9 (0.6Œ1.3)5.2 (4.7Œ5.7)Asian, non-Hispanic 1.6 (1.3Œ2.0)0.7 (0.4Œ1.0)2.3 (1.9Œ2.8)Hispanic 4.9 (4.1Œ5.6)1.5 (1.0Œ1.9)6.4 (5.4Œ7.3)Notes: CI = confidence interval. Estimated numbers for 2018 were derived from percentages for 2013Œ2016 applied to July 1, 2018 US resident population estimates from the US Census Bureau (See Detailed Methods ). Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Numbers for subgroups may not add up to the total because of rounding. Data sources: 2013Œ2016 National Health and Nutrition Examination Survey; 2018 US Census Bureau data. Trends in Prevalence of Diagnosed Diabetes, Undiagnosed Diabetes, and Total Diabetes Ł During 1999Œ2016, the age-adjusted prevalence of total diabetes signi˚cantly increased among adults aged 18 years or older (Figure 1). Ł Prevalence estimates were 9.5% in 1999Œ2002 and 12.0% in 2013Œ2016 ( Appendix Table 2 ).Ł During this period, the age-adjusted prevalence signi˚cantly increased for diagnosed diabetes. No signi˚cant change in undiagnosed diabetes prevalence was detected (Figure 1; Appendix Table 2 ).Figure 1. Trends in age-adjusted prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes among adults aged 18 years or older, United States, 1999Œ2016. Notes: Diagnosed diabetes was based on self-report. Undiagnosed diabetes was based on fasting plasma glucose and A1C levels among people self-reporting no diabetes. Data source: 1999Œ2016 National Health and Nutrition Examination Surveys. 0461012 14821999Œ20002001Œ20022003Œ20042005Œ20062007Œ20082009Œ20102011Œ20122013Œ20142015Œ2016 Age-adjusted Percentage Time Period Total Diabetes Diagnosed Diabetes Undiagnosed Diabetes
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National Diabetes Statistics Report, 2020 4Prevalence of Diagnosed Diabetes (See Detailed Methods )Among the US population overall, crude estimates for 2018 were: Ł 26.9 million people of all agesŠor 8.2% of the US populationŠhad diagnosed diabetes. Ł 210,000 children and adolescents younger than age 20 yearsŠor 25 per 10,000 US youthsŠ had diagnosed diabetes. This includes 187,000 with type 1 diabetes. Ł 1.4 million adults aged 20 years or olderŠor 5.2% of all US adults with diagnosed diabetesŠreported both having type 1 diabetes and using insulin. Ł 2.9 million adults aged 20 years or olderŠor 10.9% of all US adults with diagnosed diabetesŠstarted using insulin within a year of their diagnosis. Among US adults aged 18 years or older, age-adjusted data for 2017Œ2018 indicated the following: Ł Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%) ( Appendix Table 3 ). Ł American Indians/Alaska Natives had the highest prevalence of diagnosed diabetes for women (14.8%) (Figure 2; Appendix Table 3 ). Ł American Indian/Alaska Native men had a signi˚cantly higher prevalence of diagnosed diabetes (14.5%) than non-Hispanic black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic white (8.6%) men (Figure 2; Appendix Table 3 ). Ł Among adults of Hispanic origin, Mexicans (14.4%) and Puerto Ricans (12.4%) had the highest prevalences, followed by Central/South Americans (8.3%) and Cubans (6.5%) ( Appendix Table 3 ).Ł Among non-Hispanic Asians, Asian Indians (12.6%) and Filipinos (10.4%) had the highest prevalences, followed by Chinese (5.6%). Other Asian groups had a prevalence of 9.9% ( Appendix Table 3 ).Ł Among adults, prevalence varied signi˚cantly by education level, which is an indicator of socioeconomic status. Speci˚cally, 13.3% of adults with less than a high school education had diagnosed diabetes versus 9.7% of those with a high school education and 7.5% of those with more than a high school education ( Appendix Table 3 ).Figure 2. Age-adjusted estimated prevalence of diagnosed diabetes by race/ethnicity group and sex for adults aged 18 years or older, United States, 2017Œ2018 Note: Error bars represent upper and lower bounds of the 95% confidence interval. Data sources: 2017Œ2018 National Health Interview Survey; 2017 Indian Health Service National Data Warehouse (for American Indian/ Alaska Native group only). American Indian/ Alaska Native Asian, Non-HispanicBlack, Non-HispanicHispanicWhite, Non-Hispanic Age-adjusted Percentage Race/Ethnicity 4610121614820Men Women
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National Diabetes Statistics Report, 2020 6Table 2. Estimated crude incidence of diagnosed diabetes among adults aged 18 years or older, United States, 2017Œ2018 Characteristic Population Estimates, 2018 aNumber in thousands (95% CI)Incidence Estimates, 2017Œ2018 Rate per 1,000 (95% CI) Total 1,483 (1,289Œ1,677)6.9 (5.8Œ8.3)bAge in years 18Œ44452 (343Œ561)4.3 (3.2Œ5.9)b45Œ64706 (571Œ840)9.9 (7.6Œ12.8)b˛65326 (253Œ398)8.8 (6.5Œ11.9)bSex Men 745 (614Œ875)7.3 (5.8Œ8.3)bWomen 738 (601Œ876)6.6 (5.1Œ8.4)bRace/ethnicity White, non-Hispanic 786 (666Œ906)5.4 (4.6Œ6.3)Black, non-Hispanic 213 (148Œ279)7.9 (5.9Œ10.8)Asian, non-Hispanic 97 (58Œ137)7.2 (4.8Œ10.8)Hispanic 334 (204Œ464)9.0 (6.1Œ13.3)CI = confidence interval. a Population estimates for 2018 were derived from rates for 2017Œ2018 applied to July 1, 2018 US resident population estimates from the US Census Bureau (See Detailed Methods ). b Rates were calculated using 2018 data only. Data sources: 2017Œ2018 National Health Interview Survey and 2018 US Census Bureau data. Figure 4. Trends in age-adjusted incidence of diagnosed diabetes among adults aged 18 years or older, United States, 2000Œ2018 Notes: Data shown are estimated incidence rates (solid blue line) and 95% confidence intervals (shaded). Joinpoint identified in 2008 (See Detailed Methods ).Data source: 2000Œ2018 National Health Interview Survey. 2000200220042006200820102012201420162018Year 02 4 6 810 12 14 Age-adjusted Rate per 1,000 Trends in Incidence Among Adults Ł Among adults aged 18 years or older, the age-adjusted incidence of diagnosed diabetes was similar in 2000 (6.2 per 1,000 adults) and 2018 (6.7 per 1,000 adults). A signi˚cant decreasing trend in incidence was detected from 2008 (8.4 per 1,000 adults) through 2018. (Figure 4).
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National Diabetes Statistics Report, 2020 7County-Level Incidence Among Adults Among US adults aged 20 years or older, age-adjusted, county-level data indicated: Ł Estimates of diagnosed diabetes incidence varied across US counties, ranging from 1.2 to 46.2 per 1,000 persons in 2016 (For more detail, see US Diabetes Surveillance System ).Ł Median county-level incidence of diagnosed diabetes was 10.1, 11.0 and 10.3 per 1,000 persons in 2004, 2008, and 2016, respectively (For more detail, see US Diabetes Surveillance System ).Incidence Among Children and Adolescents Data from the SEARCH for Diabetes in Youth Study indicated that during 2014Œ2015, the estimated annual number of newly diagnosed cases in the United States included: Ł 18,291 children and adolescents younger than age 20 years with type 1 diabetes. Ł 5,758 children and adolescents age 10 to 19 years with type 2 diabetes. Trends in Incidence Among Children and Adolescents Among US children and adolescents aged less than 20 years, modeled data in Figure 5 showed: Ł For the period 2002Œ2015, overall incidence of type 1 diabetes signi˚cantly increased. Ł During 2002Œ2010, Hispanic children and youth had the largest signi˚cant increases in incidence of type 1 diabetes. Ł During 2011Œ2015, non-Hispanic Asian and Paci˚c Islander children and youth had the largest signi˚cant increases in incidence of type 1 diabetes. Among US children and adolescents aged 10 to 19 years, modeled data in Figure 5 showed: Ł For the entire period 2002Œ2015, overall incidence of type 2 diabetes signi˚cantly increased. Ł During the 2002Œ2010 and 2011Œ2015 periods, changes in incidence of type 2 diabetes were consistent across race/ethnic groups. Speci˚cally, incidence of type 2 diabetes remained stable among non-Hispanic whites and signi˚cantly increased for all others, especially non-Hispanic blacks. Figure 5. Trends in incidence of type 1 and type 2 diabetes in youth, overall and by race/ethnicity, 2002Œ2015 White, non-Hispanic Black, non-Hispanic Hispanic Asian Paci˜c Islander, non-Hispanic Overall 010 20 30 40 50 2003200520072009201120132015 Incidence per 100,000 Index Year Type 1 Diabetes (age 0Œ19 years) 010 20 30 40 50 2003200520072009201120132015 Incidence per 100,000 Index Year Type 2 Diabetes (age 10Œ19 years) Note: Adapted from Divers et al. (2020). 1 Data are model-adjusted incidence estimates (See Detailed Methods ).Data source: SEARCH for Diabetes in Youth Study.
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National Diabetes Statistics Report, 2020 8Prevalence of Prediabetes Among Adults Ł An estimated 88 million adults aged 18 years or older had prediabetes in 2018 (Table 3). Ł Among US adults aged 18 years or older, crude estimates for 2013Œ2016 were: »34.5% of all US adults had prediabetes, based on their fasting glucose or A1C level (Table 3). »10.5% of adults had prediabetes based on both elevated fasting plasma glucose and A1C levels (Appendix Table 5 ). »15.3% of adults with prediabetes reported being told by a health professional that they had this condition (Table 3). Among US adults aged 18 years or older, age-adjusted data for 2013Œ2016 indicated: Ł A higher percentage of men (37.4%) than women (29.2%) had prediabetes ( Appendix Table 6 ).Ł Prevalence of prediabetes was similar among all racial/ethnic groups and education levels (Appendix Table 6 ).Table 3. Estimated number, percentage, and awareness of prediabetes a among adults aged 18 years or older, United States, 2013Œ2016 and 2018 Characteristic Prediabetes, a 2018 Estimates Number in millions (95% CI)Prediabetes, a 2013Œ2016 Estimates Percentage (95% CI) Prediabetes Awareness, b 2013Œ2016 Estimates Percentage (95% CI) Total 88.0 (82.2Œ93.8)34.5 (32.2Œ36.9)15.3 (12.8Œ18.3)Age in years 18Œ4428.7 (25.3Œ32.1)24.3 (21.4Œ27.4)8.8 (5.9Œ13.0)45Œ6435.1 (33.0Œ37.3)41.7 (39.1Œ44.4)16.0 (12.8Œ19.8)˛6524.2 (22.0Œ26.4)46.6 (42.3Œ51.0)22.6 (17.2Œ29.1)Sex Men 40.9 (37.6Œ44.3)38.0 (34.5Œ41.2)11.4 (8.5Œ15.2)Women 47.1 (42.9Œ51.3)31.2 (28.6Œ34.0)19.8 (15.9Œ24.5)Race/ethnicity White, non-Hispanic 54.8 (49.7Œ59.8)33.9 (30.7Œ37.2)15.8 (12.2Œ20.1)Black, non-Hispanic 11.4 (10.4Œ12.5)36.9 (33.5Œ40.1)16.8 (13.6Œ20.5)Asian, non-Hispanic 5.0 (4.5Œ5.4)32.8 (29.6Œ36.2)9.8 (6.1Œ15.6)Hispanic 14.6 (13.5Œ15.8)35.4 (32.6Œ38.3)10.8 (8.1Œ14.3)Note: CI = confidence interval. Data are crude estimates (See Detailed Methods ). a Prediabetes was defined as fasting plasma glucose values of 100 to 125 mg/dL or A1C values of 5.7% to 6.4%. b Prediabetes awareness was based on self-report and estimated only among adults with prediabetes. Data sources: 2013Œ2016 National Health and Nutrition Examination Survey; 2018 US Census Bureau data. Trends in Prevalence of Prediabetes Among Adults Ł There were no signi˚cant changes in age-adjusted prevalence of prediabetes from 2005Œ2008 to 2013Œ2016 (Appendix Table 7 ). About one-third of US adults had prediabetes over the entire period. Ł Among adults with prediabetes, the age-adjusted percentage aware that they had this condition doubled from 6.5% to 13.3% between 2005Œ2008 and 2013Œ2016 ( Appendix Table 7 ).
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National Diabetes Statistics Report, 2020 9Risk Factors for Diabetes-Related Complications Among US adults aged 18 years or older with diagnosed diabetes, crude estimates for 2013Œ2016 shown in Appendix Table 8 were: Smoking Ł 21.6% were tobacco users based on self-report or levels of serum cotinine. Ł 15.0% reported current cigarette smoking. Ł 36.4% had quit smoking but had a history of smoking at least 100 cigarettes in their lifetime. Overweight and Obesity Ł 89.0% were overweight or had obesity, de˚ned as a body mass index (BMI) of 25 kg/m 2 or higher. Speci˚cally: »27.6% were overweight (BMI of 25.0 to 29.9 kg/m 2). »45.8% had obesity (BMI of 30.0 to 39.9 kg/m 2). »15.5% had extreme obesity (BMI of 40.0 kg/m 2 or higher).Physical Inactivity Ł 38.0% were physically inactive, de˚ned as getting less than 10 minutes a week of moderate or vigorous activity in each physical activity category of work, leisure time, and transportation. A1C Ł 50.0% had an A1C value of 7.0% or higher. Speci˚cally: »22.3% had an A1C value of 7.0% to 7.9%. »13.2% had an A1C value of 8.0% to 9.0%. »14.6% had an A1C value higher than 9.0%. Ł 16.3% of adults aged 18Œ44 years had A1C levels of 10% or higher, compared to 12.7% of those aged 45Œ64 years and 4.3% of those aged 65 years or older ( Appendix Table 9 ).High Blood Pressure Ł 68.4% had a systolic blood pressure of 140 mmHg or higher or diastolic blood pressure of 90 mmHg or higher or were on prescription medication for their high blood pressure ( Appendix Table 8 ).High Cholesterol *Ł 43.5% had a non-HDL level of 130 mg/dL or higher. Speci˚cally: »22.4% had a non-HDL level of 130 to 159 mg/dL. »11.2% had a non-HDL level of 160 to 189 mg/dL. »9.9% had a non-HDL level of 190 mg/dL or higher. * Non-high-density lipoprotein cholesterol (non-HDL) contains all the atherogenic lipoproteins, including low-density lipoprotein cholesterol (LDL), very-low-density lipoprotein, lipoprotein(a), and others. Growing evidence supports non-HDL as a better predictor of cardiovascular disease risk than LDL. 2
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