Prevalence of Prediabetes and Undiagnosed Diabetes in Canada (2007–2011) According to Fasting Plasma Glucose and HbA1c Screening Criteria

Abstract

OBJECTIVETo provide the first population-based estimates of prediabetes and undiagnosed type 2 diabetes prevalence in Canada. RESEARCH DESIGN AND METHODSWe combined two fasting subsamples of the Canadian Health Measures Survey, which were restricted to nonpregnant adults ‡20 years of age (N = 3,494). Undiagnosed diabetes was defined as not having self-reported type 2 diabetes but having blood glucose measures that met Canadian guidelines (i.e., fasting plasma glucose [FPG] level of ‡7.0 mmol/L or hemoglobin A 1c [HbA 1c ] level of ‡6.5% [ ‡48 mmol/mol]). Prediabetes was defined as an FPG level of ‡6.1 and <7.0 mmol/L or an HbA 1c level of ‡6.0% and <6.5% ( ‡42 and <48 mmol/mol). All estimates were weighted using survey sampling weights. CIs were calculated with the bootstrap method. RESULTSAccording to FPG levels, the prevalence of undiagnosed type 2 diabetes in Canadian adults was 1.13% (95% CI 0.79, 1.62), contributing to ∼20% of total type 2 diabetes prevalence (5.62 [95% CI 4.52, 6.95]). Compared with FPG levels, the undiagnosed prevalence was greater using HbA 1c level as a criterion (3.09% [95% CI 1.97, 4.81]), ∼41% of the total number of cases of diabetes (7.55 [95% CI 5.98,9.49]). The HbA 1c -only criterion resulted in a threefold increase in prediabetes prevalence overall and a sixfold increase among females (FPG 2.22%, HbA 1c 13.31%). Screening based on FPG only identified older undiagnosed case patients, with a mean age of 58.7 years (95% CI 59.9, 63.4). Similarly, using HbA 1c identified younger individuals with prediabetes, with reduced BMI and waist circumference compared with FPG levels. CONCLUSIONSIn this first study of a nationally representative sample with biospecimen measures, we found that the prevalence of undiagnosed type 2 diabetes and prediabetes was significantly higher using HbA 1c levels compared with FPG levels. Further evaluation is needed to fully assess the impact of using the HbA 1c criterion.

Diabetes incidence and prevalence in Hong Kong, China during 2006–2014

“…Socio-economic development leading to greater health awareness and improved health service delivery for noncommunicable diseases during the intervening two decades were likely to have reduced the proportion of undiagnosed [9]. In high-income countries such as the USA and Canada, 36.4% and 40.9% of cases were undiagnosed, respectively [9,21]. Applying the estimates from the USA and Canada gives an adjusted overall prevalence range of 12.59% to 17.43% in Hong Kong, comparable with levels in economically developed regions of mainland China.…”

Assessing Dysglycemia Risk Among Younger Adults: A Validation of the Canadian Diabetes Risk Questionnaire

“…weight loss, increased physical activity) have been shown to postpone and even prevent diabetes development in those with prediabetes (12e17). Furthermore, an estimated 20% to 40% of Canadians with diabetes have not been diagnosed (2,18,19). Earlier diagnosis of diabetes in this population can improve disease management and reduce the risk of comorbidities, mitigating some of the health impacts of diabetes (20).…”

Population-based study of the association between food insecurity and preventable hospitalization among persons with diabetes using linked survey and administrative data

“…Diabetes prevalence has been found to be higher among men than women, and among those in lower income groups compared to more affluent Canadians, as assessed using self-reports from the Canadian Community Health Survey (CCHS) [3]. Based on blood samples collected through the Canadian Health Measures Survey, Rosella et al estimated that at least 20% of type 2 diabetes cases remain undiagnosed [4].…”