The Impact of Family History on the Public Health Burden of Diagnosed Diabetes, Undiagnosed Diabetes and Prediabetes in the United States: Using Family History for Diabetes Control and Prevention

This blog post is a summary of our recently published paper in Genetics in Medicine.

Type 2 diabetes is a major public health problem in the United States and globally. Among adults 20 years and older, 9.2% have diagnosed diabetes (DD), 3.1% have undiagnosed diabetes (UD), and 36% have prediabetes (PD), a major precursor for progression to diabetes. Along with overweight, physical inactivity, increasing age, high blood pressure, and minority race/ ethnicity groups, family history of diabetes has long been known to be an important risk factor for the occurrence of type 2 diabetes. While there are a few genetic disorders associated with the risk of type 2 diabetes, the cause of most type 2 diabetes is multifactorial involving the interaction of many genes (polygenic inheritance) and environmental/ behavioral risk factors.

In our recent paper, we quantified the population health impact of reported family health history on diagnosed diabetes (DD), undiagnosed diabetes (UD), and prediabetes (PD) in the United States. We used population data from the National Health Examination and Nutrition Survey 2009 to 2014 to measure public health importance of family history as a risk factor associated with DD, UD, and PD.

Given the high prevalence of reported family history and the high prevalence of diabetes and PD, our findings suggest that millions of people who have DD, UD, and PD in the United States can be identified using family history in first degree relatives. Among people 20 years and older in the US, 9.3% had DD, almost half of whom have their diabetes attributable to family history (burden of more than 10 million people). Around 3.4% of adults who were not diagnosed with diabetes had UD with more than 20% population attributable fraction for family history of diabetes (burden of more than 1.4 million people). Finally, 40% of the population without diabetes had PD with 5% attributable to family history (burden of nearly 3.9 million people). We estimated that, in the US, 10.1 million DD cases, 1.4 million UD cases, and 3.9 million PD cases can be attributed to having a family history of diabetes.

CDC and partners have made a concerted effort to educate the general public about the importance of collecting family health history for diabetes and other common chronic diseases using systematic free online tools. After a decade of such efforts, a recent national survey found that most people do not actively collect family health history, even though the vast majority believe it is important for their own health. It is also important to note that information available about the accuracy of such data is sparse.

In spite of the recent interest and focus on genomics and precision medicine, family health history continues to be an integral component of public health campaigns to identify persons at high risk for developing type 2 diabetes and for early detection of diabetes to prevent or delay complications. Additional national efforts are needed, especially among high risk groups such as Hispanics, non-Hispanic blacks, and people with BMI ≥ 30 kg/m², to obtain information on family history that may contribute to reduction of incidence of type 2 diabetes, and early diagnosis of diabetes to help prevent or delay complications.