Trends in Prevalence of Diabetes, Pre-Diabetes, and Cardiometabolic Risk Factor Control Among U.S. Adults, 2013-2023

The objective of this study was to estimate the prevalence and trends in prevalence of dysglycemia in the United States (U.S.).

This is a repeat cross-sectional analysis of adults age ≥ 20 years who participated in the National Health and Nutrition Examination Survey (NHANES) between 2013-2023. Age-standardized pre-diabetes, undiagnosed diabetes, diagnosed diabetes, and total diabetes prevalence were estimated for each of the 4 survey cycles, then stratified by sociodemographic and clinical characteristics. Linear trends were estimated using logistic regression. Prevalence calculations and trend analyses were repeated to assess the proportion of participants meeting glycemic, blood pressure, and lipid control targets.

Among 24 230 participants across all survey years, 6773 had pre-diabetes, and 4784 had diabetes (3826 diagnosed/958 undiagnosed). The age-adjusted prevalence of total diabetes was stable across the study period: 14.6% (95% CI 13.0%-16.2%) in 2013-2014 and 16.3% (14.6%-18.0%) in 2021-2023 (prevalence ratio (PR) 1.07 [95% CI 0.90-1.26], p-trend = 0.47). The age-adjusted prevalence of pre-diabetes increased significantly during the study period from 26.4% (23.7%-29.1%) in 2013-2014 to 30.7% (28.4%-33.0%) in 2021-2023 (p-trend = 0.04, PR 1.12 [1.02-1.23]).

While the prevalence of diabetes has stabilized over the last decade, the rise in pre-diabetes signals a growing population at risk for future cardiometabolic and kidney disease.