In the JournalsPerspective

After 20-year increase, new diabetes cases decline 35%

Cases of newly diagnosed diabetes in the United States have declined 35% since the peak year of 2009, and the prevalence of the disease has remained stable for 8 years, with the trends reflected across all age, sex and racial groups, according to an analysis of National Health Interview Survey data.

Stephen Benoit

The numbers represent the longest period of a sustained plateau in diagnosed diabetes prevalence in the U.S. since the 1980s and the longest period of declining incidence ever, according to the researchers.

“A number of factors can be driving the observed reduction in diagnosed diabetes incidence,” Stephen Benoit, MD, MPH, medical officer and team lead for surveillance in the CDC’s Division of Diabetes Translation, told Endocrine Today. Lifestyle change interventions to prevent type 2 diabetes continue, such as the National Diabetes Prevention Program, as well as population approaches to improve healthy food availability, diabetes awareness and education, and walkability of communities. However, risk factors for diabetes, such as obesity and prediabetes, remain high, and since our analysis relies on diagnosed cases, the potential impact of changes in screening, testing and diagnostic thresholds are also important considerations.”

Benoit and colleagues calculated annual prevalence and incidence of diagnosed diabetes among adults using cross-sectional survey data from the National Health Interview Survey from 1980 to 2017. Researchers calculated trends in rates by age group, sex, race and education using annual percentage change.

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Cases of newly diagnosed diabetes in the United States have declined 35% since the peak year of 2009.

The overall prevalence of age-adjusted, diagnosed diabetes did not change between 1980 (3.5%) and 1990 (3.4%), but increased 4.4% per year from 1990 to 2009 to a peak of 8.2 per 100 adults (P < .001), and then plateaued through 2017, when the rate was 8 per 100 adults, according to researchers. The observed trend was similar in analyses stratified by age, sex, race and education, apart from adults with more than a high school education, who experienced a 1.1% annual increase in diabetes prevalence between 2005 and 2017 (P = .005).

The overall incidence per 1,000 adults of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, increased 4.8% per year from 1990 to 2007 to 7.8 per 1,000 adults (P < .001), and then decreased by 3.1% per year to 6 per 1,000 adults (P < .001) in 2017.

The researchers noted that the decrease in diabetes incidence was driven by white adults, who experienced a 5.1% annual decrease in diabetes incidence after 2008 (P = .002). In age-stratified analyses, researchers found that the overall decrease in diabetes incidence was most influenced by adults aged 65 to 79 years from 2011 to 2017; however, the rate of decline among this age group did not rise to statistical significance, according to researchers.

“The findings suggest that our work to stem the tide of type 2 diabetes may be working, but we still have a very long way to go,” Ann Albright, PhD, director of the division of diabetes translation at the CDC, said in a press release announcing the findings. “We must continue proven interventions and deploy innovative strategies if we’re going to see a continued decline in type 2 diabetes among Americans.”

Ann Albright

Despite progress, the burden of diabetes remains high, Benoit said.

“We urge a continued emphasis on multilevel, multidisciplinary prevention to reduce both type 2 diabetes and diabetes complications,” Benoit said. “Continued surveillance is also needed to monitor progress.”

In a presentation at the American Association of Diabetes Educators annual meeting in August and reported by Endocrine Today, Albright said both the National Diabetes Prevention Program and Medicare Diabetes Prevention Program offer opportunities to “turn the tide” of rising diabetes prevalence and create an impact at the population level.

The heart of the National Diabetes Prevention Program is a CDC-approved curriculum that relies on public-private partnerships with community organizations, private and public insurers, employers, health care organizations, faith-based organizations and government agencies, Albright said.

“You need to have a common set of metrics, you need to have a common agenda, and that is what the National [Diabetes Prevention Program] affords us,” Albright said at the time. – by Regina Schaffer

For more information:

Stephen R. Benoit, MD, MPH, can be reached at the CDC, Division of Diabetes Translation, 1600 Clifton Road, Atlanta, GA 30329; email: bvy8@cdc.gov.

Disclosures: The authors report no relevant financial disclosures.

Cases of newly diagnosed diabetes in the United States have declined 35% since the peak year of 2009, and the prevalence of the disease has remained stable for 8 years, with the trends reflected across all age, sex and racial groups, according to an analysis of National Health Interview Survey data.

Stephen Benoit

The numbers represent the longest period of a sustained plateau in diagnosed diabetes prevalence in the U.S. since the 1980s and the longest period of declining incidence ever, according to the researchers.

“A number of factors can be driving the observed reduction in diagnosed diabetes incidence,” Stephen Benoit, MD, MPH, medical officer and team lead for surveillance in the CDC’s Division of Diabetes Translation, told Endocrine Today. Lifestyle change interventions to prevent type 2 diabetes continue, such as the National Diabetes Prevention Program, as well as population approaches to improve healthy food availability, diabetes awareness and education, and walkability of communities. However, risk factors for diabetes, such as obesity and prediabetes, remain high, and since our analysis relies on diagnosed cases, the potential impact of changes in screening, testing and diagnostic thresholds are also important considerations.”

Benoit and colleagues calculated annual prevalence and incidence of diagnosed diabetes among adults using cross-sectional survey data from the National Health Interview Survey from 1980 to 2017. Researchers calculated trends in rates by age group, sex, race and education using annual percentage change.

#
Cases of newly diagnosed diabetes in the United States have declined 35% since the peak year of 2009.

The overall prevalence of age-adjusted, diagnosed diabetes did not change between 1980 (3.5%) and 1990 (3.4%), but increased 4.4% per year from 1990 to 2009 to a peak of 8.2 per 100 adults (P < .001), and then plateaued through 2017, when the rate was 8 per 100 adults, according to researchers. The observed trend was similar in analyses stratified by age, sex, race and education, apart from adults with more than a high school education, who experienced a 1.1% annual increase in diabetes prevalence between 2005 and 2017 (P = .005).

The overall incidence per 1,000 adults of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, increased 4.8% per year from 1990 to 2007 to 7.8 per 1,000 adults (P < .001), and then decreased by 3.1% per year to 6 per 1,000 adults (P < .001) in 2017.

The researchers noted that the decrease in diabetes incidence was driven by white adults, who experienced a 5.1% annual decrease in diabetes incidence after 2008 (P = .002). In age-stratified analyses, researchers found that the overall decrease in diabetes incidence was most influenced by adults aged 65 to 79 years from 2011 to 2017; however, the rate of decline among this age group did not rise to statistical significance, according to researchers.

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“The findings suggest that our work to stem the tide of type 2 diabetes may be working, but we still have a very long way to go,” Ann Albright, PhD, director of the division of diabetes translation at the CDC, said in a press release announcing the findings. “We must continue proven interventions and deploy innovative strategies if we’re going to see a continued decline in type 2 diabetes among Americans.”

Ann Albright

Despite progress, the burden of diabetes remains high, Benoit said.

“We urge a continued emphasis on multilevel, multidisciplinary prevention to reduce both type 2 diabetes and diabetes complications,” Benoit said. “Continued surveillance is also needed to monitor progress.”

In a presentation at the American Association of Diabetes Educators annual meeting in August and reported by Endocrine Today, Albright said both the National Diabetes Prevention Program and Medicare Diabetes Prevention Program offer opportunities to “turn the tide” of rising diabetes prevalence and create an impact at the population level.

The heart of the National Diabetes Prevention Program is a CDC-approved curriculum that relies on public-private partnerships with community organizations, private and public insurers, employers, health care organizations, faith-based organizations and government agencies, Albright said.

“You need to have a common set of metrics, you need to have a common agenda, and that is what the National [Diabetes Prevention Program] affords us,” Albright said at the time. – by Regina Schaffer

For more information:

Stephen R. Benoit, MD, MPH, can be reached at the CDC, Division of Diabetes Translation, 1600 Clifton Road, Atlanta, GA 30329; email: bvy8@cdc.gov.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Osama Hamdy

    Osama Hamdy

    These data are interesting, and there is a lot behind the numbers here. What is strange is that you see an immediate drop in the diabetes incidence rate beginning in 2010 — not a slow decrease. It is like there is a tipping point and then a decrease, whereas the prevalence holds steady. Many things can explain these changes. Over time, we have diagnosed diabetes in many different ways, including fasting glucose with various cutoffs, and then later, around 2010, we started to use the HbA1c assay for diagnosis. This is not a very sensitive test, but it is an easy, simple way to diagnose diabetes for physicians, as it does not require fasting and is less hassle vs. an oral glucose tolerance test or fasting plasma glucose. However, the use of HbA1c assay is likely way underestimating the prevalence and the incidence of diabetes. Obesity, as we know, continues to rise, which does not match the diabetes trend despite being linked. That said, one can also make the argument on the other side of the aisle that we are diagnosing prediabetes more often than before, and at the same time, there is a major effort going on at all levels to take action, prevent diabetes and cut related costs. All of this can explain what we are seeing here.

    • Osama Hamdy, MD, PhD, FACE
    • Medical Director, Obesity Clinical Program
      Director of Inpatient Diabetes Program, Joslin Diabetes Center
      Harvard Medical School

    Disclosures: Hamdy reports he receives research support from the National Dairy Council and Novo-Nordisk and is a consultant for Abbott Nutrition and Merck, an advisor for Astra-Zeneca and a stock holder in Healthimation Inc.