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Elevated A1C in adults without a history of diabetes in the U.S.

ABSTRACT: The purpose of this study was to examine the prevalence and correlates of elevated A1C in a large, nationally representative sample of adults without diabetes in the U.S.We analyzed data from 15,934 participants aged >or=20 years without diagnosed diabetes who had A1C measurements in the 1999-2006 National Health and Nutrition Examination Survey, a cross-sectional and nationally representative sample of the U.S. population.The overall prevalence of A1C >6% was 3.8%, corresponding to 7.1 million adults without diabetes in the U.S. population. Approximately 90% of these individuals had fasting glucose >or=100 mg/dl. Older age, male sex, non-Hispanic black race/ethnicity, hypercholesterolemia, higher BMI, and lower attained education were significantly associated with having a higher A1C level even among individuals with normal fasting glucose (<100 mg/dl) and after multivariable adjustment.A single elevated A1C level (A1C >6%) is common in the general population of adults without a history of diabetes and is highly reliable for the detection of elevated fasting glucose. Nondiabetic adults with elevated A1C are likely to have impaired fasting glucose and an array of other risk factors for type 2 diabetes and cardiovascular disease.

SUBMITTER: Selvin E

PROVIDER: S-EPMC2671106 | biostudies-literature | 2009 May

REPOSITORIES: biostudies-literature

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Elevated A1C in adults without a history of diabetes in the U.S.

Selvin Elizabeth E Zhu Hong H Brancati Frederick L FL

Diabetes care 20090205 5

<h4>Objective</h4>The purpose of this study was to examine the prevalence and correlates of elevated A1C in a large, nationally representative sample of adults without diabetes in the U.S.<h4>Research design and methods</h4>We analyzed data from 15,934 participants aged >or=20 years without diagnosed diabetes who had A1C measurements in the 1999-2006 National Health and Nutrition Examination Survey, a cross-sectional and nationally representative sample of the U.S. population.<h4>Results</h4>The ...[more]

PMID: 19196895

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Project description:INTRODUCTION:Strong evidence shows that lifestyle change and weight loss stimulated by counseling improve glycemic control and lower comorbidities for patients with diabetes, but it is unclear whether diet or physical activity counseling for patients with diabetes in ambulatory settings has actually been responsive to this evidence. METHODS:Data from the 2005-2015 National Ambulatory Medical Care Surveys were used to assess trends in provider-reported diet or exercise counseling during ambulatory care visits. The data were pooled and multivariate logistic regression models were built, adjusting for patient-, provider-, and practice-level characteristics to examine whether the provision of counseling varied by these characteristics. Data were analyzed from September 2018 to December 2018. RESULTS:There were 42,234 adults with diabetes and 272,094 adults without diabetes. The proportions of patients with provider-reported Type 2 diabetes who received any diet or exercise counseling were no different over time, 30% in 2005 (95% CI=25%, 35%) and 25% in 2015 (95% CI=18%, 31%). Lower proportions of those without diabetes received any counseling, 17% in 2005 (95% CI=14%, 19%) and 15% in 2015 (95% CI=11%, 18%). Adjusted models showed that Hispanic patients had a higher likelihood of receiving diet or exercise counseling, compared with whites (OR=1.38, 95% CI=1.09, 1.75). Those aged 30-49 years were more likely to receive diet or exercise counseling than those aged >75 years (OR=1.51, 95% CI=1.27, 1.80). Compared with rural areas and other providers, visits in a metropolitan area (OR=1.27, 95% CI=1.09, 1.47) or with an advanced practice provider (OR=1.66, 95% CI=1.00, 2.75) had a higher likelihood of any diet or exercise counseling delivery. CONCLUSIONS:Less than 30% of Americans with diabetes receive diet or exercise counseling in ambulatory visits, and this proportion has not changed significantly in a decade. Future interventions should focus on addressing this gap in counseling.

Project description:Dysfunctional insulin signaling may affect brain metabolism or amyloid deposition. We investigated the associations of type 2 diabetes with amyloid accumulation measured using (11)C-Pittsburgh compound B ((11)C-PiB) and brain hypometabolism measured using (18)F-FDG PET.We studied a sample of nondemented participants from the population-based Mayo Clinic Study of Aging. All subjects underwent MR imaging, amyloid PET, and (18)F-FDG PET. Alzheimer disease (AD) signature and region-of-interest (ROI) measures for (11)C-PiB retention ratio and (18)F-FDG ratio were measured. Diabetes was assessed from the Rochester Epidemiology Project medical records linkage system.Among 749 participants (median age, 79.0 y; 56.5% men, 81.0% cognitively normal; 20.6% diabetic individuals), (18)F-FDG hypometabolism ((18)F-FDG ratio < 1.31) in the AD signature meta-ROI was more common in diabetic individuals (48.1%) than in nondiabetic individuals (28.9%; P < 0.001). The median (18)F-FDG ratio was lower in diabetic individuals than in nondiabetic individuals in the AD signature meta-ROI (1.32 vs. 1.40, P < 0.001) and in the angular (1.40 vs. 1.48, P < 0.001) and posterior cingulate gyri ROIs (1.63 vs. 1.72, P < 0.001). The odds ratio (OR) for abnormal AD signature (18)F-FDG hypometabolism was elevated (2.28; 95% confidence interval [CI], 1.56-3.33) in diabetic individuals versus nondiabetic individuals after adjustment for age, sex, and education and after additional adjustment for apolipoprotein ?4 allele, glycemic level, and cognitive status (OR, 1.69; 95% CI, 1.10-2.60). However, the AD signature (11)C-PiB retention ratio was similar in diabetic individuals versus nondiabetic individuals (OR, 1.03; 95% CI, 0.71-1.51; P = 0.87). In post hoc analyses in nondiabetic individuals, a 1% increase in hemoglobin A1c was associated with greater AD signature hypometabolism in cognitively normal subjects (OR, 1.93; 95% CI, 1.03-3.62; P = 0.04) and in the total cohort (OR 1.59; 95% CI, 0.92-2.75; P = 0.10).Diabetes and poor glycemic control in nondiabetic individuals may enhance glucose hypometabolism in AD signature regions. These factors should be investigated in longitudinal studies for their role in detecting onset of symptoms in AD.

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Elevated A1C in adults without a history of diabetes in the U.S.

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Elevated A1C in adults without a history of diabetes in the U.S.

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