Menke Andy, Knowler William C., Cowie Catherine C.
Dr. Andy Menke is a Senior Research Analyst at Social & Scientific Systems, Inc., Silver Spring, MD
Dr. William C. Knowler is the Chief of the Diabetes Epidemiology and Clinical Research Section at the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
This chapter provides a description of physical and metabolic characteristics of persons with diabetes and prediabetes and is based primarily on data from the National Health and Nutrition Examination Surveys 2005–2010. The 2010 American Diabetes Association guidelines were used to define undiagnosed diabetes and prediabetes. Among participants with diabetes, mean glycosylated hemoglobin (A1c) concentrations were highest in those with diagnosed diabetes treated by insulin or oral diabetes medication (7.4%), followed by undiagnosed diabetes defined by A1c or fasting plasma glucose (6.9%), and lowest among those with untreated diagnosed diabetes (6.3%) and undiagnosed diabetes defined by A1c, fasting plasma glucose, or 2-hour plasma glucose (6.3%). Mean fasting plasma glucose concentrations were highest in those with treated diabetes (153 mg/dL) and undiagnosed diabetes defined by A1c or fasting plasma glucose (149 mg/dL) and generally lower among those with untreated diagnosed diabetes (137 mg/dL) and undiagnosed diabetes defined by A1c, fasting plasma glucose, or 2-hour plasma glucose (130 mg/dL). Mean 2-hour plasma glucose concentrations were higher in those with undiagnosed diabetes (243 mg/dL for A1c and fasting plasma glucose definition; 235 mg/dL for A1c, fasting plasma glucose, and 2-hour plasma glucose definition) than in people with untreated diagnosed diabetes (183 mg/dL; 2-hour plasma glucose was not measured in participants with treated diagnosed diabetes). Participants with prediabetes by definition had lower A1c, fasting plasma glucose, and 2-hour plasma glucose concentrations than those with diabetes, and participants with normal glucose regulation had the lowest concentrations. Mean fasting insulin concentrations were generally higher in people with undiagnosed diabetes than in people with diagnosed diabetes (insulin users were excluded). Participants with prediabetes generally had lower fasting insulin concentrations than those with undiagnosed diabetes, and those with normal glucose regulation had the lowest fasting insulin concentrations. The prevalence of family history of diabetes was generally highest among people with diagnosed diabetes (69%), followed by undiagnosed diabetes (49% for A1c and fasting plasma glucose definition; 45% for A1c, fasting plasma glucose, and 2-hour plasma glucose definition), and was lowest in those with prediabetes (39%) and normal glucose regulation (33%). People with diabetes had higher mean body mass index and systolic blood pressure than people with prediabetes, and those with normal glucose regulation had the lowest means. The relationship between diabetes and cholesterol level differed by age group. Mean levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides were generally higher in people with diabetes age 20–44 years than in people with prediabetes or normal glucose regulation. Conversely, mean levels of total cholesterol, LDL cholesterol, and triglycerides were generally lower in people with diabetes age 45–64 years than those with prediabetes or normal glucose regulation. The prevalence of C-reactive protein ≥10 mg/L was generally higher among people with diabetes than among people with prediabetes, and people with normal glucose regulation generally had the lowest prevalence. Women with diagnosed diabetes had a higher age-standardized mean number of live births than women who had not been diagnosed with diabetes. Individuals with diagnosed diabetes reported a higher prevalence of fair or poor health than those with prediabetes or normal glucose regulation.
本章描述了糖尿病患者和糖尿病前期患者的身体及代谢特征，主要基于2005 - 2010年国家健康与营养检查调查的数据。采用2010年美国糖尿病协会指南来定义未诊断的糖尿病和糖尿病前期。在糖尿病患者中，使用胰岛素或口服降糖药治疗的已诊断糖尿病患者的糖化血红蛋白（A1c）平均浓度最高（7.4%），其次是通过A1c或空腹血糖定义的未诊断糖尿病患者（6.9%），而未治疗的已诊断糖尿病患者（6.3%）以及通过A1c、空腹血糖或餐后2小时血糖定义的未诊断糖尿病患者（6.3%）的A1c平均浓度最低。空腹血糖平均浓度在接受治疗的糖尿病患者（153 mg/dL）和通过A1c或空腹血糖定义的未诊断糖尿病患者中最高（149 mg/dL），而在未治疗的已诊断糖尿病患者（137 mg/dL）以及通过A1c、空腹血糖或餐后2小时血糖定义的未诊断糖尿病患者中通常较低（130 mg/dL）。未诊断糖尿病患者的餐后2小时血糖平均浓度（A1c和空腹血糖定义为243 mg/dL；A1c、空腹血糖和餐后2小时血糖定义为235 mg/dL）高于未治疗的已诊断糖尿病患者（183 mg/dL；接受治疗的已诊断糖尿病患者未测量餐后2小时血糖）。按照定义，糖尿病前期患者的A1c、空腹血糖和餐后2小时血糖浓度低于糖尿病患者，而血糖调节正常的参与者浓度最低。未诊断糖尿病患者的空腹胰岛素平均浓度通常高于已诊断糖尿病患者（排除使用胰岛素者）。糖尿病前期患者的空腹胰岛素浓度通常低于未诊断糖尿病患者，血糖调节正常者的空腹胰岛素浓度最低。糖尿病家族史的患病率通常在已诊断糖尿病患者中最高（69%），其次是未诊断糖尿病患者（A1c和空腹血糖定义为49%；A1c、空腹血糖和餐后2小时血糖定义为45%），在糖尿病前期患者（39%）和血糖调节正常者（33%）中最低。糖尿病患者的平均体重指数和收缩压高于糖尿病前期患者，血糖调节正常者的平均值最低。糖尿病与胆固醇水平的关系因年龄组而异。20 - 44岁糖尿病患者的总胆固醇、低密度脂蛋白（LDL）胆固醇和甘油三酯平均水平通常高于糖尿病前期患者或血糖调节正常者。相反，45 - 64岁糖尿病患者的总胆固醇、LDL胆固醇和甘油三酯平均水平通常低于糖尿病前期患者或血糖调节正常者。C反应蛋白≥10 mg/L的患病率在糖尿病患者中通常高于糖尿病前期患者，血糖调节正常者的患病率通常最低。已诊断糖尿病的女性的年龄标准化平均活产数高于未诊断糖尿病的女性。已诊断糖尿病的个体报告的健康状况为一般或较差的患病率高于糖尿病前期患者或血糖调节正常者。
