Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

Diabetes mellitus (DM) is a major public health problem in Oman. We evaluated the impact of the revised diagnostic criteria for DM adopted by the American Diabetes Association (ADA) on the prevalence of diabetes and impaired glucose tolerance (IGT), and on the classification of individuals among the Omani population. We used the dataset of the National Diabetes Survey, conducted in 1991 and involving 4682 subjects who did not have any missing data on fasting and 2-hour glucose. The subjects comprised 2002 males and 2680 females aged 20 years or above. Data were analyzed using the ADA criteria (diabetes as fasting plasma glucose [FPG] > or =7 mmol/L, impaired fasting glucose [IFG] as FPG > or =6.1 mmol/L and <7 mmol/L), and compared these with the World Health Organization (WHO) criteria (diabetes as FPG > or =7.8 mmol/L and/or 2-hour post-glucose load > or =11.1 mmol/L, IGT as FPG <7.8 mmol/L, and 2-hour post-load 7.8-11.1 mmol/L). Applying the ADA criteria on the Omani population resulted in an overall reduction of diabetes prevalence by 2.2% (95% confidence interval [CI] 1.6% to 2.8%), and a 4.8% reduction of IGT (95% CI 3.8% to 5.8%). Over 29% of diabetics classified by the WHO criteria were reclassified as being normal or having IFG by the ADA criteria. Around 3.6% of those who were normoglycemic by the WHO criteria were classified as having diabetes or IFG by the ADA criteria. In all but one region of Oman, the prevalence of diabetes and IFG using the ADA criteria was lower compared to the prevalence using the WHO criteria. Gender, age and body mass index did not seem to pose an increased risk to the probability of being diagnosed by one criteria or the other or both together. The adoption of the ADA criteria in Oman will significantly reduce the prevalence of diabetes and IGT. In addition, the glycemic status of a substantial number of individuals will be changed from normal to either being diabetic or having IGT.

The Highest Prevalence of Diabetes Recorded in Mainland China: A National Epidemiologic Survey

The prevalence of diabetes among Hispanic and Asian American subpopulations in the United States is unknown. To estimate racial/ethnic differences in the prevalence of diabetes among US adults 20 years or older by major race/ethnicity groups and selected Hispanic and non-Hispanic Asian subpopulations. National Health and Nutrition Examination Surveys, 2011-2016, cross-sectional samples representing the noninstitutionalized, civilian, US population. The sample included adults 20 years or older who had self-reported diagnosed diabetes during the interview or measurements of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2hPG). Race/ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic and Hispanic subgroups (Mexican, Puerto Rican, Cuban/Dominican, Central American, and South American), non-Hispanic Asian and non-Hispanic Asian subgroups (East, South, and Southeast Asian), and non-Hispanic other. Diagnosed diabetes was based on self-reported prior diagnosis. Undiagnosed diabetes was defined as HbA1c 6.5% or greater, FPG 126 mg/dL or greater, or 2hPG 200 mg/dL or greater in participants without diagnosed diabetes. Total diabetes was defined as diagnosed or undiagnosed diabetes. The study sample included 7575 US adults (mean age, 47.5 years; 52% women; 2866 [65%] non-Hispanic white, 1636 [11%] non-Hispanic black, 1952 [15%] Hispanic, 909 [6%] non-Hispanic Asian, and 212 [3%] non-Hispanic other). A total of 2266 individuals had diagnosed diabetes; 377 had undiagnosed diabetes. Weighted age- and sex-adjusted prevalence of total diabetes was 12.1% (95% CI, 11.0%-13.4%) for non-Hispanic white, 20.4% (95% CI, 18.8%-22.1%) for non-Hispanic black, 22.1% (95% CI, 19.6%-24.7%) for Hispanic, and 19.1% (95% CI, 16.0%-22.1%) for non-Hispanic Asian adults (overall P < .001). Among Hispanic adults, the prevalence of total diabetes was 24.6% (95% CI, 21.6%-27.6%) for Mexican, 21.7% (95% CI, 14.6%-28.8%) for Puerto Rican, 20.5% (95% CI, 13.7%-27.3%) for Cuban/Dominican, 19.3% (95% CI, 12.4%-26.1%) for Central American, and 12.3% (95% CI, 8.5%-16.2%) for South American subgroups (overall P < .001). Among non-Hispanic Asian adults, the prevalence of total diabetes was 14.0% (95% CI, 9.5%-18.4%) for East Asian, 23.3% (95% CI, 15.6%-30.9%) for South Asian, and 22.4% (95% CI, 15.9%-28.9%) for Southeast Asian subgroups (overall P = .02). The prevalence of undiagnosed diabetes was 3.9% (95% CI, 3.0%-4.8%) for non-Hispanic white, 5.2% (95% CI, 3.9%-6.4%) for non-Hispanic black, 7.5% (95% CI, 5.9%-9.1%) for Hispanic, and 7.5% (95% CI, 4.9%-10.0%) for non-Hispanic Asian adults (overall P < .001). In this nationally representative survey of US adults from 2011 to 2016, the prevalence of diabetes and undiagnosed diabetes varied by race/ethnicity and among subgroups identified within the Hispanic and non-Hispanic Asian populations.

To compare the 1997 American Diabetes Association (ADA) and the 1980-1985 World Health Organization (WHO) diagnostic criteria in categorization of the diabetes diagnostic status of adults in the U.S. Analyses are based on a probability sample of the U.S. population age 40-74 years in the 1988-1994 Third National Health and Nutrition Examination Survey (NHANES III). People with diabetes diagnosed before the survey were identified by questionnaire. For 2,844 people without diagnosed diabetes, fasting plasma glucose was obtained after an overnight 9 to < 24-h fast, HbA1c was measured, and a 2-h oral glucose tolerance test was administered. Prevalence of diagnosed diabetes in this age-group is 7.9%. Prevalence of undiagnosed diabetes is 4.4% by ADA criteria and 6.4% by WHO criteria. The net change of -2.0% occurs because 1.0% are classified as having undiagnosed diabetes by ADA criteria but have impaired or normal glucose tolerance by WHO criteria, and 3.0% are classified as having impaired fasting glucose or normal fasting glucose by ADA criteria but have undiagnosed diabetes by WHO criteria. Prevalence of impaired fasting glucose is 10.1% (ADA), compared with 15.6% for impaired glucose tolerance (WHO). For those with undiagnosed diabetes by ADA criteria, 62.1% are above the normal range for HbA1c compared with 47.1% by WHO criteria. Mean HbA1c is 7.07% for undiagnosed diabetes by ADA criteria and 6.58% by WHO criteria. The number of people with undiagnosed diabetes by ADA criteria is lower than that by WHO criteria. However, those individuals classified by ADA criteria are more hyperglycemic, with higher HbA1c values and a greater proportion of values above the normal range. This fact, together with the simplicity of obtaining a fasting plasma glucose value, may result in the detection of a greater proportion of people with undiagnosed diabetes in clinical practice using the new ADA diagnostic criteria.

IntroductionTo examine changes in the prevalence of diabetes and the control of risk factors for diabetes over 10 years among adults in China.MethodsTwo population‐based cross‐sectional surveys were used to obtain a nationally representative sample of adults aged 20 years and older in mainland China in 2007 (n = 46 239) and 2017 (n = 73 340). Changes in the prevalence of diabetes, impaired fasting glucose, impaired glucose tolerance, and prediabetes, as diagnosed by the World Health Organization criteria, were assessed over time.ResultsThe weighted prevalence of diagnosed diabetes (3.8% vs 6.3%, p = .0001) and total diabetes (9.7% vs 11.7%, p = .005) increased among the overall population between 2007 and 2017. The weighted prevalence of undiagnosed diabetes (5.9% vs 5.4%, p = .7), impaired fasting glucose (2.7% vs 2.6%, p = .68), impaired glucose tolerance (12.7% vs 12.5%, p = .95), prediabetes (15.4% vs 15.1%, p = .79), the treatment of diabetes (34.1% vs 32.5%, p = .44), and the control of diabetes (31.1% vs 32.8%, p = .73) did not significantly change over this period. The awareness of diabetes (39.4% vs 53.6%, p = .0004) increased over 10 years among the overall population. The proportion of achieved high‐density lipoprotein cholesterol targets increased (p = .005), but the proportion of achieved body mass index (p = .01) and waist circumference (p = .0002) targets decreased significantly.ConclusionsBetween 2007 and 2017, the prevalence of total diabetes (diagnosed by the World Health Organization criteria), especially diagnosed diabetes, increased among adults in China. Although awareness of diabetes improved, effective interventions and clinical strategies are urgently required.

Diabetes is a leading cause of death in the United States and is a significant health concern for Asian Americans. Here, Ema Ando and Mo-Kyung Sin from Seattle University College of Nursing make a case for waist measurement as an aid to screening for diabetes in Asian Americans.[Image omitted: See PDF.]Diabetes is the seventh leading cause of death in the United States.[1] It is estimated that about 29 million of the US population have diabetes.[1] Approximately 8.1 million of those with diabetes are undiagnosed.[1]Type II diabetes is a significant health issue among Asian Americans. A recent survey indicated that approximately 9.0% of Asian Americans have been diagnosed with diabetes.[1] According to the US Census Bureau,[2] Asian Americans are the fastest growing population in the United States with a 43% increase from 2000 to 2010. Understanding the difference in diabetes progression in this population is crucial for identifying those at risk.The national guidelines such as the American Diabetes Association (ADA)[3] and US Preventive Services Task Force (USPSTF)[4] currently recommend diabetes and pre-diabetes screening for those who are overweight and are at increased risk for diabetes. However, there are discrepancies in terms of body mass index (BMI) cut-off for overweight between the ADA and USPSTF. The ADA[1] and the World Health Organization (WHO)[5] recommend use of Asian BMI cut-off for overweight among Asians (BMI ≥ 23 kg/m2 ), while the USPSTF guideline is based on 25 kg/m2 for overweight. The Asian BMI cut-off could result in a greater proportion of Asian Americans being classified as overweight or obese. Researchers reported that Asian Americans have higher visceral adiposity even with normal BMI and are at greater risk of cardiometabolic disease with normal BMI.[6] Thus, it is likely that many pre-diabetic or diabetic Asian Americans may be missed.Like many other diseases, early stage of diabetes is asymptomatic. The triad of diabetic symptoms, such as polyuria, polydipsia, and polyphagia, is a sign of disease progression. Improvement of screening criteria to detect those currently undiagnosed at the earliest possible time is needed to improve health outcomes in high risk Asian Americans.Japanese Americans, for example, have a disproportionately high prevalence of diabetes while having lower BMI compared to Caucasians as well as to other Asian American subgroups.[7] According to the 2011-2012 California Health Interview Survey (CHIS), Japanese Americans were found to have the second highest prevalence of borderline diabetes (13.8%) after Filipinos and the second highest prevalence of diabetes (9.5%) after Koreans among Asian Americans.[8]Some have hypothesised that a 'westernised' lifestyle, a diet high in animal fat and a sedentary lifestyle, have caused the high prevalence of type II diabetes in the Japanese population.[9],[10] Studies acknowledge the relative significance of a diet high in meat and a sedentary lifestyle, even though these were greater risk factors for Caucasians.[11],[12] Another study found that a low fat diet and aerobic exercise decreased insulin resistance, but it did not alleviate the underlying beta-cell dysfunction and did not prevent glucose intolerance in the long term.[13]Increased body weight is a well-established risk factor for type II diabetes. Although BMI is the most widely used clinical tool to estimate body fat, it has its limitations in the estimation of body fat composition. Compared to Caucasians, Asian Americans have higher prevalence of diabetes but lower BMI.[7],[14] Researchers found that many Asian subgroups were more than 1.5 times more likely to develop type II diabetes than Caucasians.[14] This finding suggests that diabetes progression starts at a lower BMI in Asians relative to Caucasians. …

Trends in the prevalence and control of diabetes defined by hemoglobin A1c (HbA1c) levels are important for health care policy and planning. To update trends in the prevalence of diabetes, prediabetes, and glycemic control. Cross-sectional. NHANES (National Health and Nutrition Examination Survey) in 1988-1994 and 1999-2010. Adults aged 20 years or older. We used calibrated HbA1c levels to define undiagnosed diabetes (≥6.5%); prediabetes (5.7% to 6.4%); and, among persons with diagnosed diabetes, glycemic control (&lt;7.0% or &lt;8.0%). Trends in HbA1c categories were compared with fasting glucose levels (≥7.0 mmol/L [≥126 mg/dL] and 5.6 to 6.9 mmol/L [100 to 125 mg/dL]). In 2010, approximately 21 million U.S. adults aged 20 years or older had total confirmed diabetes (self-reported diabetes or diagnostic levels for both fasting glucose and calibrated HbA1c). During 2 decades, the prevalence of total confirmed diabetes increased, but the prevalence of undiagnosed diabetes remained fairly stable, reducing the proportion of total diabetes cases that are undiagnosed to 11% in 2005-2010. The prevalence of prediabetes was lower when defined by calibrated HbA1c levels than when defined by fasting glucose levels but has increased from 5.8% in 1988-1994 to 12.4% in 2005-2010 when defined by HbA1c levels. Glycemic control improved overall, but total diabetes prevalence was greater and diabetes was less controlled among non-Hispanic blacks and Mexican Americans compared with non-Hispanic whites. Cross-sectional design. Over the past 2 decades, the prevalence of total diabetes has increased substantially. However, the proportion of undiagnosed diabetes cases decreased, suggesting improvements in screening and diagnosis. Among the growing number of persons with diagnosed diabetes, glycemic control improved but remains a challenge, particularly among non-Hispanic blacks and Mexican Americans. National Institutes of Health.

Prevalence of Diabetes by BMI: China Nutrition and Health Surveillance (2015–2017) and U.S. National Health and Nutrition Examination Survey (2015–2018)

BackgroundA rapid epidemiological transition is taking place in China and the association between socioeconomic status (SES) and diabetes prevalence is not clear and may vary by population characteristics and geography within the country. We describe the associations between educational level, annual household living expenditure (AHLE) and diabetes prevalence in a large middle-aged and elderly Chinese population using data from a nationwide cross-sectional study.MethodsWe used data from the China Health and Retirement Longitudinal Study, which collected information from interviews and blood tests from a nationwide sample of people over 44 years of age in 2011-2012. We used multivariable logistic regression to describe the association between highest levels of education (high school or above compared to illiterate) or AHLE (top vs bottom quartile) and self-reported, screen-detected or total diabetes prevalence. We stratified by sex and adjusted for age, education or AHLE (as appropriate), urban, rural or migrant residence status and geographical area.ResultsComplete data were available for 10 100 participants of whom 10.5% and 28.9% had the highest and the lowest levels of education respectively. Overall prevalence of self-reported diabetes was 6.0% and of screen-detected diabetes was 9.8%. Higher education level was associated with both self-reported diabetes (odds ratio (OR) = 2.41, 95% confidence interval CI = 1.36-4.46) and total diabetes (OR = 1.53 95%, CI = 1.10-2.15) only in men. AHLE was associated with self-reported diabetes in men (OR = 1.87, 95% CI = 1.26-2.84) and women (OR = 2.31, 95% CI = 1.62-3.34). There was no association between SES and screen-detected diabetes for men or women.ConclusionsSES inequalities exist in prevalence of diabetes in China and can be used to inform approaches to prevention. Identification and appropriate intervention for people with undiagnosed diabetes is required for all SES groups.

In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Diabetes Association (ADA) recommended three new sets of criteria for the diagnosis of diabetes that were different from those established by the World Health Organization (WHO) in 1985. One of these three methods was based on a fasting plasma glucose value only. This article compares ADA criteria with WHO criteria by applying them to three subgroups of American Indians in the Strong Heart Study who had no known diabetes. The Strong Heart Study is a prospective epidemiological study of vascular disease in three American Indian populations aged 45-74 years. During the baseline examination from 1988 to 1991, participants without diagnosed diabetes underwent a fasting glucose test and a 2-h oral glucose tolerance test. These values were used to compare the ADA and WHO diagnostic criteria. By using fasting and 2-h glucose values, prevalence rates of undiagnosed diabetes were 15.9% according to WHO criteria and 14.4% according to ADA criteria. The overall agreement rate was 65%, and the weighted kappa statistic was 0.474, which indicates moderate agreement. The age-specific analysis showed that, among participants between 45 and 54 years of age, the prevalence rates of undiagnosed diabetes were 13.4% according to WHO criteria and 12.7% according to ADA criteria. Among those aged 55-74 years, the rates were 18.7% according to WHO criteria and 16.3% according to ADA criteria. Thus, the difference in the prevalence rates when using WHO and ADA criteria, although generally small in this population, was three times higher in the older group (2.4%) than the difference in the younger group (0.7%). The Strong Heart Study found that prevalence rates of undiagnosed diabetes determined by ADA criteria and WHO criteria were similar in its American Indian population. The data suggest that the difference between the two criteria may increase as age increases. Longitudinal data will be needed to evaluate further the utility of the two criteria.

To examine the implications for epidemiological studies of the American Diabetes Association (ADA) recommendation that the fasting blood glucose at a lowered level becomes the main diagnostic test for diabetes on cross-sectional-based data from sub-Saharan Africa. Data from 11 surveys conducted in rural, peri-urban and urban Cameroon (n = 1804), South Africa (n = 3799) and Tanzania (n = 10013) which measured fasting (ADA criteria) and 2-h blood glucose concentrations during a standard 75 g OGTT (old WHO criteria) were analysed. The prevalence of diabetes was higher in eight of the 11 surveys when applying the new ADA compared to the old WHO criteria. With the exception of one population (Mara, Tanzania) the absolute difference in prevalence between the two classifications tended to be small (< 2%). There was considerable variation in the categorization of individuals using the ADA and old WHO criteria. The level of agreement between the two ranged from fair to good (Kappa statistic 0.17-0.86). The prevalence of impaired fasting glycaemia (IFG) was lower than that of impaired glucose tolerance (IGT) in 10 of the surveys and the agreement between the two was fair, < or = 0.26 in all the surveys. Although the use of the new ADA fasting criteria for prevalence surveys is an attractive and practical option, particularly in Africa, further information is required on the characteristics and prognosis of individuals classified as IFG or diabetic by the fasting criteria, prior to wide adoption of the ADA criteria. Ideally measurement of both fasting and two low glucose concentrations should remain the standard for epidemiological studies.

Objective: Diabetes is a major risk factor for vascular disease in the general population. We investigated the prevalence of diabetes and glycemic control in the Chinese adult population. Methods: We conducted a cross-sectional survey in a nationally representative sample of 98,658 Chinese adults aged ≥18 years in 2010. After an overnight fast, participants without known diabetes underwent an oral glucose-tolerance test (OGTT) using 75 g anhydrous glucose dissolved in water. Previously diagnosed diabetes was determined on the basis of self-report. Undiagnosed diabetes was defined as a hemoglobin A1c (A1c) ≥ 6.5% or fasting plasma glucose (FPG) ≥126 mg/dl (7.0 mmol/l) or 2-h plasma glucose (2-h PG) ≥200 mg/dl (11.1 mmol/l) during an OGTT according to the 2010 American Diabetes Association criteria. Pre-diabetes was defined as FPG 100-125 mg/dl (5.6-6.9 mmol/l) or 2-h PG 140-199 mg/dl (7.8-11.0 mmol/l) or A1c 5.7-6.4%. Prevalence was calculated by weighting sampling factors derived from China population census data in 2010 to obtain national estimates. Results: Prevalence of self-reported diabetes was estimated to be 3.5% in the Chinese population aged ≥18 years (3.6% in men and 3.4% in women) or 34.2 million persons (18.0 million men and 16.3 million women). Prevalence of undiagnosed diabetes was 8.1% (8.5% in men and 7.7% in women) or 79.6 million persons (42.5 million men and 37.1 million women), and the prevalence of pre-diabetes was 50.1% (52.1% in men and 48.1% in women) or 493.4 million persons (260.1 million men and 233.3 million women). The prevalence of diabetes was higher in urban (14.3%) than in rural (10.3%) residents, and higher in persons who were older, heavier, and living in economically developed areas. The proportion of controlled (A1c &lt;7.0%) was 42.8% among self-reported diabetes (42.3% in men and 43.4% in women) in the general population in China. Conclusions: Our study shows that the prevalence of diabetes in the general population in China is much higher than previously reported. More troublesome, 7 out of every 10 diabetic patients are undiagnosed. Among self-reported diabetes, 3 out of 5 were poorly controlled. Our findings indicate that diabetes has become a major public health problem in China and suggest an urgent need to develop national strategies for prevention and treatment of diabetes.

The coloured population has the second-highest prevalence of diabetes in South Africa. However, the data were based on a study conducted almost 20 years ago in a peri-urban coloured population of the Western Cape. We aimed to determine the prevalence of diabetes mellitus and metabolic syndrome in an urban coloured population in South Africa. In a cross-sectional survey, 642 participants aged ≥31 years were drawn from an urban community of Bellville South, Cape Town, from mid-January 2008 to March 2009. Type 2 diabetes was assessed according to the WHO criteria, and metabolic syndrome was based on the International Diabetes Federation (IDF), ATP III and 2009 Joint Interim Statement (JIS) definition. The crude prevalence of 28.2% (age-adjusted 26.3%, 95% confidence interval (CI) 22.0 - 30.3) for type 2 diabetes was: 4.4% (age-adjusted 3.2%, 95% CI 1.6 - 4.9) for impaired fasting glycaemia, and 15.3% (age-adjusted 15.0%, 95% CI 11.4 - 18.6) for impaired glucose tolerance. Undiagnosed type 2 diabetes was present in 18.1% (age-adjusted 16.8%, 95% CI 13.3 - 20.4). The crude prevalence of metabolic syndrome was higher with the JIS definition (62.0%) than the IDF (60.6%), and the National Cholesterol Education Program (NCEP) ATP III (55.4%). There was good overall agreement between the MetS criteria, k=0.89 (95% CI 0.85 - 0.92). The prevalence of diabetes has increased hugely in the coloured community, and the high prevalence of undiagnosed diabetes portends that cardiovascular diseases might grow to epidemic proportions in the near future in South Africa.

Obesity is a major risk factor for type 2 diabetes. The prevalence of obesity in US adults, defined as a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, changed little instances, total diabetes was defined as the sum of the cases of diagnosed and undiagnosed diabetes. In 2011-2012, using the hemoglobin A1c, FPG, or 2-hour plasma glucose diabetes definition, the unadjusted prevalence was 14.3% for total diabetes, 9.1% for diagnosed diaRelated article page 1021 between 1960 and 1980 (from 13% in 1960 to 15% in betes, and 5.2% for undiagnosed diabetes. The prevalence of total diabetes was higher in older age groups but similar 1980). Subsequently, between 1980 and 2000, the prevalence of obesity in the United States doubled from 15% to 31%.1 Since then, there has been relatively little change in the prevalence of obesity among infants and toddlers, children and adolescents, or adults. Nevertheless, the prevalence of obesity is high with 8% of infants and toddlers, 17% of those aged 2 to 19 years, and 35% of US adults aged 20 years or older estimated to be obese.2,3 An earlier study of trends in diagnosed diabetes among US adults demonstrated stable incidence and prevalence rates between 1980 and 1990 and sharp increases in both incidence and prevalence each year between 1990 and 2008, but a leveling off of diabetes prevalence and a possible decrease in diabetes incidence between 2008 and 2012.4 In this issue of JAMA, Menke and colleagues5 analyzed data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of total, diagnosed, and undiagnosed diabetes in US adults in 2011-2012 and to update national trends between 1988 and 2012. The authors defined diagnosed diabetes as self-report of a previous diagnosis of diabetes. Depending on the availability of data, they used 2 definitions for undiagnosed diabetes: (1) a hemoglobin A1c level of 6.5% or greater, a fasting plasma glucose (FPG) level of 126 mg/dL or greater, or a 2-hour plasma glucose (2 hours after a 75 g oral glucose load) level of 200 mg/dL or greater or (2) a hemoglobin A1c level of 6.5% or greater or an FPG level of 126 mg/dL or greater. In both among men and women. Compared with non-Hispanic white participants in whom the age-standardized prevalence of total diabetes was 11.3%, the prevalence of total diabetes was higher in non-Hispanic black (21.8%) and Hispanic (22.6%) participants and marginally higher in nonHispanic Asian (20.6%) participants. The percentage of people with diabetes who were undiagnosed was higher among non-Hispanic Asian (50.9%) and Hispanic participants (49.0%) than among non-Hispanic black (36.8%) and non-Hispanic white (32.3%) participants. Using the hemoglobin A1c or FPG diabetes definition, the age-standardized prevalence of total diabetes increased from 9.8% in 1988-1994 to 12.5% in 2007-2008, but remained at approximately 12% between 2008 and 2012. The increase in diabetes prevalence between 1988 and 2012 was due to an increase in diagnosed diabetes. Indeed, the age-standardized percentage of total diabetes that was undiagnosed decreased from 40.3% in 1988-1994 to 31.0% in 2011-2012 in the entire US population. The percentage of total diabetes that was undiagnosed did not decrease significantly in people aged 20 to 44 years (40% in 1988 and 40% in 2012). These findings suggest that the recommendations issued by the US Surgeon General6 and the Institute of Medicine,7 the implementation of food, nutrition, agricultural, and physical activity policies and regulations by federal, state, and local governments,8 and the focus on individual behavioral change related to diet and physical activity by the US Centers for Disease Control and Prevention9 (CDC) have

The high prevalence of diabetes in non-Caucasian populations is reported not only for Native Hawaiians who suffer from high rates of obesity, but also for Japanese with a relatively low body weight. The objectives of this study were to estimate the prevalence of diabetes among participants of the Multiethnic Cohort (MEC) and to examine the association of body mass index (BMI) with self-reported diabetes by ethnicity. Cross-sectional analysis of baseline questionnaire at cohort entry. 187,439 MEC subjects in Hawaii and California from five ethnic groups. Participants completed a 26-page, self-administered survey with questions concerning anthropometrics, demographic, medical, lifestyle, and food consumption behavior. Age-adjusted prevalence of diabetes was calculated by sex and ethnicity and stratified by BMI. Prevalence ratios were determined using logistic regression while adjusting for variables that are known to be related to diabetes. The c statistic was computed to compare models with different confounders. The prevalence of self-reported diabetes in the MEC was 11.6%. The age-adjusted diabetes prevalence ranged from 6.3% in Caucasians to 10.2% in Japanese, 16.1% in Native Hawaiians, 15.0% in African Americans, and 15.8% in Latinos. After adjustment for known risk factors, the prevalence ratio by ethnicity ranged between 2.1 (African American and Latino), 2.8 (Japanese), and 3.0 (Native Hawaiian) as compared to Caucasians. These differences were observed among all BMI categories. Ethnic differences in the prevalence of diabetes persisted after stratification by BMI. The prevalence of diabetes was at least two-fold higher in all ethnic groups than among Caucasians.