From the Journals

Incidence of adult diabetes drops, prevalence remains stable



After increasing for almost 2 decades, the incidence of adult diabetes in the United States has dropped 35%, and the prevalence has held steady since about 2008, according to a review of Centers for Disease Control and Prevention data.

It’s the longest plateau in prevalence since the 1980s, and the longest period of declining incidence ever recorded. The findings suggest that efforts “to stem the tide of type 2 diabetes may be working ... [but] we still have a very long way to go,” investigator Ann Albright, PhD, director of the CDC Division of Diabetes Translation, said in a press statement.

However, the authors noted that “obesity and severe obesity trends have generally increased over the past 10 years, and prediabetes remains unchanged and high, affecting 84 million U.S. adults, or 34% of the US adult population,” and they emphasized the need for continued focus on prevention for type 2 diabetes and diabetes complications, as well as better screening and detection of the disease.

Dr Albright and her colleagues reviewed the CDC’s annual National Health Interview Survey data from 1980-2017. Diabetes diagnoses were by self-report, and the data did not distinguish between type 1 and type 2 disease, although it is known that about 95% of diabetes cases are type 2 (BMJ Open Diab Res Care. 2019 May 28;7:e000657. doi:10.1136/bmjdrc-2019-000657).

New cases declined from a high of 1.73 million in 2008 to 1.34 million in 2017, a drop of 3.1% a year, from 7.8 to 6 new cases/1,000 adults. The findings were driven largely by decreasing incidence in non-Hispanic whites.

Prevalence peaked at 8.2/100 adults in 2009, and has remained there since, possibly because people with diabetes are living longer with the disease, the investigators said.

Similar prevalence trends were seen across age, racial, education, and ethnic groups, and in both men and women. The findings were all statistically significant.

The drop in incidence corresponds with flat or downward trends in several type 2 risk factors, including sugar, soda, and total calorie intake, and physical inactivity. In 2010, the American Diabetes Association recommended hemoglobin A1c for diabetes diagnosis, which might have also decreased the incidence because it is less sensitive than traditional fasting blood glucose. Increased screening in recent years might have depleted the pool of new cases as well, the authors said.

The CDC has been emphasizing type 2 education and prevention through its National Diabetes Prevention Program, which might also have helped.

There was no external funding for the survey, and the investigators reported no disclosures or conflicts of interest.

SOURCE: Benoit SR et al. BMJ Open Diab Res Care. 2019 May 28. doi:10.1136/bmjdrc-2019-000657

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