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D-15 Data Details

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D-15 Increase the proportion of persons with diabetes whose condition has been diagnosed

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
National Health and Nutrition Examination Survey
Changed Since the Healthy People 2020 Launch: 
Yes
Measure: 
percent (age adjusted—see Comments)
Baseline (Year): 
72.5 (2005–08)
Target: 
79.8
Target-Setting Method: 
10 percent improvement
Numerator: 

Number of persons aged 20 years and over who report that they have ever been diagnosed with diabetes

Denominator: 

Number of persons aged 20 years and over who report that they have ever been diagnosed with diabetes plus the number of persons aged 20 years and over who have undiagnosed diabetes (a fasting blood glucose level greater or equal to 126 mg/dl or an HbA1c level greater or equal to 6.5)

Comparable Healthy People 2010 Objective: 
Adapted from HP2010 objective
Questions Used to Obtain the National Baseline Data: 

    From the 2005-2008 National Health and Nutrition Examination Survey:

    [NUMERATOR AND DENOMINATOR:]

    {Other than during pregnancy, {have you/has SP}/{Have you/Has SP}} ever been told by a doctor or other health professional that {you have/{he/she/SP} has} diabetes or sugar diabetes?

    1. Yes
    2. No
    3. Borderline or pre-diabetes
    4. Refused
    5. Don't know/Not stated
Data Collection Frequency: 
Periodic
Methodology Notes: 

    Persons are considered to have diagnosed diabetes if they respond “yes” to the question “have you ever been told by a doctor that you have diabetes.” Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are excluded. Persons who report that they have pre-diabetes or borderline diabetes are counted as ‘no’. The undiagnosed population with diabetes is based on the American Diabetes Association criteria.

    Data for HbA1c are available for the whole sample, but data for fasting glucose are only measured for the morning examination session. For these analysis the cohort examined is restricted to persons in the AM exam session only.

    Backward calibration equations were used to account for changes in plasma glucose laboratory procedures over time.

    Age Adjustment Notes: 

    This Indicator uses Age-Adjustment Groups:

    • Total: 20-49, 50-59, 60-69, 70-79, 80+
    • Sex: 20-49, 50-59, 60-69, 70-79, 80+
    • Race/Ethnicity: 20-49, 50-59, 60-69, 70-79, 80+
    • Educational Attainment: 25-49, 50-59, 60-69, 70-79, 80+
    • Family Income (percent poverty threshold): 20-49, 50-59, 60-69, 70-79, 80+
    • Country of Birth: 20-49, 50-59, 60-69, 70-79, 80+
    • Disability Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Health Insurance Status: 20-49, 50-59, 60-64
    • Marital Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Veteran Status: 20-49, 50-59, 60-69, 70-79, 80+
    • Obesity Status: 20-49, 50-59, 60-69, 70-79, 80+
Trend Issues: 
Hemoglobin A1c results for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were temporarily withdrawn in November 2011 to evaluate a shift to the right (increased values) in the distribution of Hemoglobin A1c in 2007-2010 compared to 1999-2006. After careful evaluation of participant data, laboratory quality control data and non-NHANES A1c studies, a cause for this shift in the distribution of Hemoglobin A1c could not be identified. Therefore, the Hemoglobin A1c data for 2007-2008 (GHB_E) and 2009-2010 (GHB_F) were re-released in March 2012 without changes to the data. The user will need to carefully consider the information presented in this analytic note when analyzing Hemoglobin A1c data from 1999-2010.
Changes Between HP2010 and HP2020: 
This objective tracks the same measure as Healthy People 2010 objective 5-4, however the American Diabetes Association (ADA) released new diabetes diagnosis criteria in the year 2010. For Healthy People 2010, undiagnosed diabetes was determined using fasting glucose levels. For Healthy People 2020, following the newest guidelines, undiagnosed diabetes is determined using both fasting glucose levels as well as A1c levels.

Revision History

Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

Description of Changes Since the Healthy People 2020 Launch: 
In 2015 the programming for this objective was revised to more explicitly exclude pregnant women from the analysis and apply the fasting weight to the entire measure (it was previously applied only to the part of the measure that used laboratory data). As a result the baseline was revised from 72.8% to 72.5%, and the target was revised from 80.1% to 79.8% using the original target setting method.