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Cited by 1,306Diabetes Management and ResearchDiabetes, Cardiovascular Risks, and LipoproteinsRetinal Diseases and Treatments

Onset of NIDDM occurs at Least 4–7 yr Before Clinical Diagnosis

Harris, Maureen I, Klein, Ronald, Welborn, Tim A, Knuiman, Matthew W·1992·Diabetes Care
DOI 10.2337/diacare.15.7.815
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Abstract

Objective To investigate duration of the period between diabetes onset and its clinical diagnosis. Research design and methods Two population-based groups of white patients with non-insulin-dependent diabetes (NIDDM) in the United States and Australia were studied. Prevalence of retinopathy and duration of diabetes subsequent to clinical diagnosis were determined for all subjects. Weighted linear regression was used to examine the relationship between diabetes duration and prevalence of retinopathy. Results Prevalence of retinopathy at clinical diagnosis of diabetes was estimated to be 20.8% in the U.S. and 9.9% in Australia and increased linearly with longer duration of diabetes. By extrapolating this linear relationship to the time when retinopathy prevalence was estimated to be zero, onset of detectable retinopathy was calculated to have occurred approximately 4-7 yr before diagnosis of NIDDM. Because other data indicate that diabetes may be present for 5 yr before retinopathy becomes evident, onset of NIDDM may occur 9-12 yr before its clinical diagnosis. Conclusions These findings suggest that undiagnosed NIDDM is not a benign condition. Clinically significant morbidity is present at diagnosis and for years before diagnosis. During this preclinical period, treatment is not being offered for diabetes or its specific complications, despite the fact that reduction in hyperglycemia, hypertension, and cardiovascular risk factors is believed to benefit patients. Imprecise dati…

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Authors
Harris, M. I., Klein, R., Welborn, T. A., & Knuiman, M. W.
Affiliations
  • University of Wisconsin–Madison (US)
  • National Diabetes Data Group, National Institute of Diabetes and Digestive and Kidney Diseases Bethesda, Maryland; the Department of Ophthalmology, University of Wisconsin Medical School Madison, Wisconsin; and the Department of Medicine, University of Western Australia Perth, Australia
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
1992-07-01
Volume
15
Issue
7
Pages
815-819
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.15.7.815
OpenAlex
W1965139875
Cited by
1,306
References
0
Citations by year
2026: 19 · 2025: 16 · 2024: 33 · 2023: 34 · 2022: 39 · 2021: 47 · 2020: 31 · 2019: 49 · 2018: 42 · 2017: 42 · 2016: 37 · 2015: 56 · 2014: 71 · 2013: 59 · 2012: 61
FWCI
10.79
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Eye Institute (EY0-3083, R01EY003083)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
Keywords
type 2 diabetes, diabetes onset, preclinical diabetes, diabetes duration, diabetic retinopathy, retinopathy prevalence, undiagnosed diabetes, diabetes complications, diabetes etiology
MeSH terms
Australia, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Humans, Time Factors, United States, Prevalence, Linear Models

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