Blood spot-based measures of glucose homeostasis and diabetes prevalence in a nationally representative population of young US adults

Ann Epidemiol. 2014 Dec;24(12):903-9.e1. doi: 10.1016/j.annepidem.2014.09.010. Epub 2014 Oct 22.


Purpose: We investigated understudied biomarker-based diabetes among young US adults, traditionally characterized by low cardiovascular disease risk.

Methods: We examined 15,701 participants aged 24 to 32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health, 2008). The study used innovative and relatively noninvasive methods to collect capillary whole blood via finger prick at in-home examinations in all 50 states.

Results: Assays of dried blood spots produced reliable and accurate values of HbA1c. Reliability was lower for fasting glucose and lowest for random glucose. Mean (SD) HbA1c was 5.6% (0.8%). More than a quarter (27.4%) had HbA1c-defined prediabetes. HbA1c was highest in the black, non-Hispanic race/ethnic group, inversely associated with education, and more common among the overweight/obese and physically inactive. The prevalence of diabetes defined by previous diagnosis or use of antidiabetic medication was 2.9%. Further incorporating HbA1c and glucose values, the prevalence increased to 6.8%, and among these participants, 38.9% had a previous diagnosis of diabetes (i.e., aware). Among those aware, 37.6% were treated and 64.0% were controlled (i.e., HbA1c < 7%).

Conclusions: A contemporary cohort of young adults faces a historically high risk of diabetes but there is ample opportunity for early detection and intervention.

Keywords: Diabetes mellitus; Dried blood spot testing; Glucose; HbA1c; Health surveys; Young adult.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Black People / statistics & numerical data
  • Black or African American / statistics & numerical data
  • Blood Glucose / analysis
  • Blood Glucose / metabolism*
  • Body Mass Index
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Dried Blood Spot Testing / methods*
  • Female
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism*
  • Homeostasis*
  • Humans
  • Longitudinal Studies
  • Male
  • Nutrition Surveys
  • Prevalence
  • Reproducibility of Results
  • White People / statistics & numerical data
  • Young Adult


  • Blood Glucose
  • Glycated Hemoglobin A