Abstract 15738: The Awareness, Treatment, and Control of LDL-Cholesterol is Lower Among US Adults with Undiagnosed versus Diagnosed Diabetes

Abstract

Diabetes is a coronary heart disease (CHD) risk equivalent in the ATP III guidelines. Many individuals with diabetes are undiagnosed, resulting in a missed opportunity for the primary prevention of CHD. We conducted a cross-sectional analysis of NHANES 2005-2010 to determine whether US adults with undiagnosed diabetes had lower rates of awareness, treatment, and control of elevated low density lipoprotein cholesterol (LDL-C). NHANES participants who were ≥20 years of age with a 10 year Framingham CHD risk score <20% who were free of CHD and stroke and fasted 9 to 24 hours prior to the study visit (n=5,213) were categorized based on diabetes status: 1) normal glucose, 2) impaired fasting glucose, 3) undiagnosed diabetes, and 4) diagnosed diabetes. Diabetes was defined as use of antidiabetes medications, hemoglobin A1C ≥ 6.5%, or fasting plasma glucose ≥126 mg/dL. Individuals who met criteria for diabetes but did not report a prior diabetes diagnosis were considered to have undiagnosed diabetes. Impaired fasting glucose was defined as a hemoglobin A1C of 5.7-6.4% or a fasting plasma glucose of 100-125 mg/dL. High LDL-C was defined based on the 2004 revised ATP III guidelines. Of participants with diabetes, 243 (35%) were undiagnosed. Mean LDL-C was higher in those with undiagnosed versus diagnosed diabetes (118 ± 3 mg/dL versus 102 ± 2 mg/dL; p<0.001). Compared to individuals with diagnosed diabetes, those with undiagnosed diabetes had a similar prevalence of high LDL-C but less awareness of and treatment for elevated LDL-C (Table). Only 16.3% of individuals with undiagnosed diabetes achieved LDL-C control compared to 39.6% of those with diagnosed diabetes. The gap in controlled LDL-C was smaller and not statistically significant when limited to those taking lipid-lowering medication. More emphasis on screening for diabetes is necessary to identify individuals who require more intensive LDL-C reduction.