Clinical Review

Confronting the Diabetes Epidemic

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Obesity and type 2 diabetes mellitus (DM) are major clinical and public health problems in the U.S. From 1980 to 2012, the number of U.S. adults with diagnosed DM nearly quadrupled. More than 21 million Americans have DM and another 8.1 million people with DM are undiagnosed. 1 Hispanics, non-Hispanic blacks, and American Indians/Alaska Natives are disproportionately impacted with rates up to twice as high as whites. The CDC estimates that 40% of the adult population will develop DM during their lifetime, and > 50% of Hispanic men and women and non-Hispanic black women are predicted to develop the disease. 2

A 2015 CDC study analyzed 2011 and 2012 National Health and Nutrition Examination Survey data and estimated that the prevalence of DM for all American adults was 12% to 14%. 3 Diabetes mellitus prevalence increased in every age, sex, level of education, income, and racial/ethnic group. Although the proportion of people with DM who were undiagnosed decreased, more than half of Asian Americans and nearly half of Hispanics with DM remained undiagnosed. Prediabetes, an important predicator of the risk of developing DM, also increased from about 33% to 37% to 38%. 2,3 It was estimated that 49% to 53% of Americans have either DM or prediabetes. 3

The increase in incidence of DM has been attributed to a rise in the prevalence of obesity, which doubled between 1980 and 2000. Current estimates place the prevalence of obesity at 35% for adults aged – 20 years. The primary components of DM prevention in adults are weight loss and increased physical activity. The Diabetes Prevention Program study showed that participants in the lifestyle intervention group—those receiving intensive individual counseling and motivational support on effective diet, exercise, and behavior modification—reduced their risk of developing DM by 58%. Evidence suggests that higher intensity programs are more likely to lead to greater weight loss and reduction in new onset disease. However, even small and incremental steps in improving diet and increasing activity can produce benefits for individuals.

Recommendations issued by the U.S. Surgeon General and the Institute of Medicine (IOM) focus on not only personal behaviors, but also characteristics of the social and physical environment.4,5 The IOM recognizes 5 critical goals for preventing obesity: (1) integrating physical activity into people’s daily lives; (2) making healthful food and beverage options routinely and easily available; (3) transforming marketing and messages about nutrition and activity; (4) making schools a focal point for obesity prevention; and (5) galvanizing employers and health care professionals to support healthy lifestyles.

A multifaceted approach toward prevention and management is needed to combat DM and obesity. Changes in U.S. society have resulted in decreases in physical activity and increases in caloric intake. Communities without safe environments to walk and play, lacking affordable and healthful food options, and surrounded by advertisements for unhealthful food and beverage options will continue to struggle with obesity and DM. Broad changes are needed to support and sustain individuals and families. As health care providers, we can have profound effects in assisting patients to achieve better health by encouraging, motivating, and empowering them with the tools needed to make these changes for meaningful and permanent lifestyle changes.

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