Prevalence of diabetes: the cup is half empty and half full

In the Sept 8, 2015, issue of JAMA, investigators present new data on the prevalence of diabetes and prediabetes in U.S. adults as of 2012. A quick scan of the article is an alarming experience, though the authors point out there is some reason for optimism.

Most concerning is that a little more than half the adult population of this country has either diabetes or prediabetes. Specifically, 14.3% of adults have diabetes and 36.4% have prediabetes. Those are remarkable numbers, especially since many prediabetics will end up with diabetes. This does not bode well for the long-term future, given the many adverse health consequences of diabetes.

The investigators identified some notable racial and demographic differences in diabetes prevalence:

  • People of African descent had a 21.8% prevalence of diabetes, while Asians had a prevalence of 20.6%. Latinos had a prevalence of 22.6%.
  • The prevalence of pre-diabetes was highest among the white population.
  • While the risk of diabetes is closely linked to obesity, for any given BMI, Asians have a higher risk of diabetes than other ethnicities with the same BMI.
  • The better educated a person is, the lower the prevalence of diabetes.
  • Ditto for income status—more income equals less diabetes.

So, where are the glimmers of hope to be found? One positive point is that fewer diabetics now are undiagnosed than in years past. Though about one third of diabetics are not diagnosed, that is an improvement from 25 years ago, when 40% of diabetics did not know they had it. We seem to be doing a better job of screening and educating our patients. Another positive finding is that while the prevalence of diabetes has increased from 25 years ago, there appears to have been little change over the most recent four years for which data is available. Most of the increase in prevalence occurred prior to 2008. There seems to be a recent leveling off in development of diabetes, which hopefully will continue. Maybe all of the publicity about diet, obesity, and exercise is starting to have an impact.

Clearly, we have our work cut out for us as far as tackling the diabetes epidemic.

Richard Fleming, MD

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