JOHNSON CITY, TN — Overall prevalence of diabetes was 20% for the general U.S. population but nearly 25% for veterans, according to a recent study using data from the National Health and Nutrition Examination Survey (NHANES).

The study published in the national Centers for Disease Control and Prevention’s publication Preventing Chronic Disease was led by researchers from East Tennesee State University.

“Diabetes is more prevalent among U.S. veterans than among the general population,” the study authors pointed out. “This high prevalence is primarily attributable to the high prevalence of obesity among this population. Obesity and diabetes are genetically linked. People with obesity are more prone to the major contributors to Type 2 diabetes—insulin resistance and β cell dysfunctions.”

The study noted that diabetes was the seventh-leading cause of death in the United States in 2013, adding that about 30.3 million Americans had diabetes, including an estimated 7.2 million who had the disease but had not received a diagnosis.

The report also warned that diabetes is associated with multiple chronic conditions, including cardiovascular diseases, stroke and disorders leading to amputation. The estimated annual cost of diabetes on the U.S. health care system overall is $245 billion, researcher pointed out.

For the study, researchers used data from 5 NHANES cycles conducted from 2005 through 2014. Diabetes in a participant was defined as having at least one of four conditions:

1) a glycated hemoglobin A1c of 6.5% or higher,
2) fasting plasma glucose of 126 mg/dL or higher,
3) a two-hour plasma glucose of 200 mg/dL or higher, or
4) a diagnosis of diabetes by a physician or other healthcare provider.

Results indicated that the overall pooled weighted prevalence of diabetes in NHANES for 2013-2014 was 20.5% (95% confidence interval [CI], 15.9–25.2%), and the prevalence of undiagnosed diabetes was 3.4% (95% CI, 1.1%–5.6%).

Diabetes was found to be most prevalent among veterans aged 65 years or older (27%), among male veterans (22%), among veterans with less than 12 years of education (33.5%) and among veterans with an annual income below the 100% federal poverty level (FPL) (23.8%).

The highest prevalence of obesity, meanwhile, was among veterans aged 45 to 64 years (53.1%), male veterans (41.1%), veterans with less than 12 years of education (51.4%) and veterans living below the 100% FPL (47.2%).

The study stated that poverty level (P= .005) and education (P= .03) were significantly associated with the odds of diabetes.

Overall, the study authors reported, the highest prevalence of diabetes (25.7%) and obesity (43.5%) was observed among Hispanic veterans.

Prevalence increased significantly among male veterans, from 16.5% in 2005–2006 to 22.0% in 2013–2014 (P= .04 for trend test), the article noted, while the prevalence of diabetes among veterans who had less than 12 years of education increased from 21.9% in 2005–2006 to 33.5% in 2013–2014 (P= .04 for trend test).

Among veterans with more than 12 years of education, the prevalence increased at a slower rate, however, from 12.3% in 2005-2006 to 19.9% in 2013-2014 (P = .03 for trend test).

1Liu, Y., Sayam, S., Shao, X., Wang, K., Zheng, S., Li, Y., & Wang, L. (2017). Prevalence of and Trends in Diabetes Among Veterans, United States, 2005–2014. Preventing Chronic Disease, 14, E135.