Epidemiology of Diabetes and Pre-Diabetes in Older Adults

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1 Epidemiology of Diabetes and Pre-Diabetes in Older Adults ASP Workshop on Diabetes Mellitus and Cardiovascular Disease in Older Adults: Edward Gregg Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention The findings and conclusions in this presentation are those of the author and do not necessarily represent those of the Centers for Disease Control and Prevention Methods for Discussion Topic #1: Clinical Epidemiology of Diabetes Mellitus and Concomitant Cardiovascular Disease in an Aging Population National Surveillance Systems : National Health and Nutrition Examination Surveys (NHANES) National Hospital Discharge Survey: (NHDS) National Health Interview Survey (NHIS) Behavior Risk Factor Surveillance System (BRFSS) Cohort Studies and Registries Kaiser Permanente Northern California Diabetes Registry The Diabetes Study of Northern California (DISTANCE) Cardiovascular Health Study (CHS) Atherosclerosis and Risk in Communities (ARIC) Health and Retirement Survey (HRS) Pooled Cohort Analyses and Meta-Analyses: Emerging Risk Factors Collaboration DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) Sarwar et al., PLoS Med, National Diabetes Surveillance System 1

2 Age-Adjusted Percentage of Adults Aged 65 Years with Diagnosed Diabetes, 2009 (Behavior Risk Factor Surveillance System) CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at Comparison of Glycemic Criteria for Diabetes and Pre-Diabetes or High Risk States Across Major Clinical and Guidelines Committees (American Diabetes Association, American Association of Clinical Endocrinology / American College of Clinical Endocrinology, European Association for Study of Diabetes / World Health Organization) Organizations FPG (mg/d) Diabetes 2-hr glucose (mg/dl) HbA1c (%) ADA; ACE/AACE; EASD/WHO >126 > 200 > 6.5 FPG (mg/d) High Risk States 2-hr glucose (mg/dl) HbA1c (%) American Diabetes Association >100 > to 6.4 American Assoc. Clin Endocrin ology / American College of Endocrinology >100 > to 6.4 only as screener World Health Organization >110 >140 Not Appropriate 2

3 Prevalence of Diagnosed and Undiagnosed Diabetes in the U.S. Adult Population, Age 65, According to Alternative Glycemic Definitions of Undiagnosed Diabetes Prevalence Diagnosed Undiagnosed FPG A1c 2 hr FPG or A1c FPG, A1c, or 2hr Glycemic Test Used in Definition (>126 mg/dl) (>6.5%) (>200 mg/dl) Prevalence of Diagnosed and Undiagnosed Diabetes and Pre-Diabetes in the U.S. Adult Population, Age 65, According to Alternative Definitions Prevalence Diagnosed Undiagnosed Pre Diabetes FPG A1c 2 hr FPG or A1c FPG, A1c, or 2hr Glycemic Test Used in Definition (>100 mg/dl) (>5.7%) (>140 mg/dl) 3

4 Mozaffarian et al., Arch Intern Med,

5 Summary of Diabetes Complications: Trends in Incidence (events per 1000 per year) of Major Complications of Diabetes Over 2 Decades Among U.S. Adults age with Diabetes National Diabetes Surveillance System; Incidence (per 1000) of Major Diabetes Complications According to Age among Adults with Diabetes, 2009 National Diabetes Surveillance System; 5

6 Key Questions and Literature Gaps for the Application of Epidemiology to Prevention Effectiveness: Given the high prevalence of undiagnosed diabetes and dysglycemia/pre diabetes in older adults? Do the heterogeneous glycemic subgroups matter in terms of future risk; And what are their implications for screening? Which subgroups are the best candidates for intervention? Is the spectrum of risk factors, or their magnitudes of association, different for older adults than young and middleaged adults? What additional information is needed to improve risk stratification for intervention? 6