In the Journals

Diabetes rates surged along with obesity, but BMI doesn't explain higher incidence in men

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September 2, 2014

The rise in diabetes rates in the United States over the past several decades has been strongly influenced by the rise in obesity, according to research published in Annals of Internal Medicine.

Researchers determined two periods during which prevalence of diabetes nearly doubled, 1976 to 1980 and 1999 to 2004, and discovered rates rose more in men than in women in these times.

Andy Menke, PhD, a senior research analyst at Social and Scientific Systems in Silver Spring, Maryland, and colleagues from other institutions, analyzed data from five National Health and Nutrition Examination Surveys (NHANES) to assess relationships between the surge in diabetes and changing distributions of race and ethnicity, age and obesity prevalence in adults.

The cross-sectional investigation included 23,932 patients with diabetes aged 20 to 74 years; diabetes was defined as either self-reported diagnosis or fasting plasma glucose ≥7.0 mmol/L (126 mg/dL). The surveys used were NHANES II (1976 to 1980), NHANES III (1988 to 1994) and the continuous NHANES from 1999 to 2002, 2003 to 2006, and 2007 to 2010.

From 1976 to 1980 and 2007 to 2010, diabetes prevalence rose from 4.7% to 11.2% in men and from 5.7% to 8.7% in women (P for both groups <.001). With adjustments for age, race and ethnicity and BMI, diabetes rates rose in men (6.2% to 9.6%; P<.001) but not in women (7.6% to 7.5%; P<.69).

Among the three covariates, BMI was the strongest contributor to the change in estimates after adjustment. However, BMI could not fully explain the disparity seen between men and women.

In the study, the researchers acknowledged that not having data available for possible risk factors including physical activity, waist circumference and mortality could present limitations. But they also emphasized two important implications.

“The substantial contribution of BMI to the prevalence of diabetes in both men and women supports ongoing public health efforts to address obesity, including developing effective interventions aimed at reducing obesity,” the researchers wrote. “Our finding that nearly half of the diabetes increase in men remains unexplained gives urgency to research investigating what additional factors may contribute to the faster rise in diabetes in men than in women.”

Disclosures: The research was supported by a contract from the National Institute of Diabetes and Digestive and Kidney Diseases.

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