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Diabetes Prevalence & Trends: An Update

Diabetes Prevalence & Trends: An Update
Author Information (click to view)

Matt Petersen

Director, Information Resources
American Diabetes Association

Matt Petersen has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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Matt Petersen (click to view)

Matt Petersen

Director, Information Resources
American Diabetes Association

Matt Petersen has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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This Physician’s Weekly feature updating the prevalence of diabetes and associated trends was completed in cooperation with the experts at the American Diabetes Association.

According to recent data, diabetes continues to be a major cause of morbidity and mortality in the United States, costing an estimated $245 billion due to greater use of healthcare resources and lost productivity. Recent analysis of the scope of both diagnosed and undiagnosed diabetes in the U.S. gives new perspectives on where the challenges and opportunities lie in changing the course of the disease.

New Data

In a recent study published in JAMA, investigators estimated the prevalence of diagnosed diabetes, undiagnosed diabetes, and total diabetes (diagnosed plus undiagnosed populations) using data collected in the 1988-1994 and the 1999-2000 to 2011-2012 National Health and Nutrition Examination Surveys (NHANES).

“Research shows that the prevalence of diagnosed diabetes and undiagnosed diabetes has increased in the U.S. during the past few decades,” says Matt Petersen. “We now have new survey data available to estimate diabetes prevalence and trends, including data on minority populations that we haven’t had before. This information can help clinicians identify areas of unmet need and determine where to dedicate available resources to improve outcomes and enhance quality of life for patients living with the disease.”

For the study, the authors used data from 2,781 adults from NHANES 2011-2012 to estimate the recent prevalence of diabetes and an additional 23,634 adults from 1988-2010 to examine long-term trends. “These data can help healthcare providers examine changes over time and gain a better understanding of current patient demographics,” explains Petersen.

For the analysis, the research team defined diabetes prevalence as a previous diagnosis of diabetes or, if diabetes was not previously diagnosed, by A1C, fasting plasma glucose (FPG) levels, or 2-hour (PG). A1C levels were defined as 6.5% or higher, FPG levels were 126 mg/dL or greater, and 2-hour PG levels were 200 mg/dL or higher. The analysis also includes prevalence data using only A1C and fasting glucose levels, without the 2-hour PG, since the first two tests are the ones most commonly used in the clinical setting.

Recent Trends

Using all three tests when analyzing the 2011-2012 NHANES population, the unadjusted prevalence was 9.1% for diagnosed diabetes and 5.2% for undiagnosed diabetes, resulting in a combined rate of 14.3% for total diabetes. Among patients who had diabetes, 36.4% were undiagnosed with the disease. “The percentage of undiagnosed diabetes was around 50% in the mid-1990s and declined for a number of years, but has been stuck stubbornly at around 35% in recent years,” says Petersen.

Researchers also found that the total prevalence of diabetes among white study participants (11.3%) was about half that of blacks (21.8%), Asians (20.6%), and Hispanics (22.6%). The age-standardized percentage of diabetes cases that were undiagnosed was significantly higher for Asians (10.6%) and Hispanics (10.1%) than for non-Hispanic whites (3.8%) or blacks (7.0%). “With this new data, we’re beginning to see the severe impact of diabetes—both diagnosed and undiagnosed—among other racial and ethnic populations,” Petersen says. “These patient groups warrant more attention from clinicians.”

Petersen notes that the JAMA study is among the first to provide detailed national estimates of the prevalence of diabetes among Asians in the U.S. The Asian population was oversampled in NHANES for the first time in 2011-2012. Petersen says more years of oversampling may provide additional information about specific Asian subgroups and trends over time. “This data is also important because Asians may be screened less frequently for diabetes because they often have lower BMIs at a comparable degree of diabetes risk,” he says. Recently, the American Diabetes Association recommended that all Asian American adults presenting with a BMI of 23 kg/m2 or higher be considered for diabetes screening. This BMI cut point is lower than that of other U.S. adults, which is 25 kg/m2 or higher.

Long-Term Results

Between 1988-1994 and 2011-2012, the prevalence of diabetes increased significantly among the overall U.S. population (Figure). Trends in the prevalence of diabetes also increased among each patient age group, both sexes, and every racial and ethnic group. The study authors noted that prevalence trends also increased in every educational and income level and reported that there were especially rapid diabetes prevalence increases in black and Mexican-American participants.

Important Implications

“Importantly, the JAMA study found that the proportion of people who had undiagnosed diabetes decreased significantly over the study period, which is an encouraging sign,” Petersen says. “However, other data shows that this decline has plateaued, and we should not become complacent. There may be several reasons as to why this occurred. The decline in undiagnosed diabetes may be the result of a combination of better screening for diabetes and better survival among people with diagnosed diabetes.” He adds that similar improvements may not have occurred among Hispanics and younger people with diabetes due to a lower percentage of these people having health insurance, which in turn reduces access to healthcare.

“The prevalence and trends from this study are important to helping clinicians understand and recognize shifting demographics that need to be addressed,” says Petersen. “In the future, it will be important to continue monitoring trends among racial and ethnic minorities, particularly Asian Americans, to enhance efforts aimed at reducing healthcare disparities among vulnerable populations.”

Readings & Resources (click to view)

Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314:1021-1029. Available at: http://jama.jamanetwork.com/article.aspx?articleid=2434682.

 

American Diabetes Association. Standards of Medical Care in Diabetes—2015. Diabetes Care. 2015;38:S1-S93.
American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36:1033-1046.

 

Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the US population in 1988-1994 and 2005-2006. Diabetes Care. 2009;32:287-294.

 

Geiss LS,Wang J, Cheng YJ, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012. JAMA. 2014;312:1218-1226.

 

Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med. 2014;160:517-525.

1 Comment

  1. In July of 2015, it was discovered that I had type 2 diabetes. By the end of the month, I was given a prescription for Metformin. I stated the ADA diet and followed it completely for several weeks but was unable to get my blood sugar below 140. With no results to how for my hard work, I panicked and called my doctor. His response? Deal with it. I began to feel that something wasn’t right and do my own research. Then I found Rachel’s blog http://curediabetespro.gq/ . I read it from cover to cover and I started the diet and by the next morning, my blood sugar was 100. Since then, I have a fasting reading between the mid 70s and 80s. My doctor was so surprised at the results that, the next week, he took me off the Metformin. I lost 30 pounds in the first month and lost more than 6 inches off my waist and I’m able to work out twice a day while still having lots of energy. The truth is we can get off the drugs and help myself by trying natural methods.

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