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Diabetes and obesity rates

New US diabetes cases fall as obesity rises

It found the rate of new diabetes cases fell to six per 1,000 US adults in 2017, from 9.2 per 1,000 in 2009, a 35 percent drop and marks the longest decline since the government started tracking the statistic nearly 40 years ago, according to the CDC

The number of new diabetes cases among US adults keeps falling, even as obesity rates climb, according to research led by Dr Stephen Benoit of the Centers for Disease Control and Prevention. The new federal data revealed the number of new diabetes diagnoses fell to about 1.3 million in 2017, down from 1.7 million in 2009, a decline that has been going on for close to a decade. However, health officials are not celebrating.

"The bottom line is we don't know for sure what's driving these trends," said Benoit. Among the possibilities are changes in testing and getting people to improve their health before becoming diabetic. In addition, other factors might have pushed up annual diabetes diagnoses from 2000 to 2010, and they may partly explain why the numbers have been going down since. For example, the diagnostic threshold was lowered in the late 1990s, which resulted in more people been diagnosed as diabetic, but the impact of that may have played out.

The paper, ‘New directions in incidence and prevalence of diagnosed diabetes in the USA’, published in BMJ Open Diabetes Research & Care, sought to determine whether diabetes prevalence and incidence has remained flat or changed direction during the past five years.

The researchers calculated annual prevalence and incidence of diagnosed diabetes (type 1 and type 2 combined) for civilian, non-institutionalised adults aged 18–79 years using annual, nationally representative cross-sectional survey data from the National Health Interview Survey from 1980 to 2017. Trends in rates by age group, sex, race/ethnicity, and education were calculated using annual percentage change (APC).

Overall, the prevalence of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, but increased significantly (APC 4.4%) from 1990 to 2009 to a peak of 8.2 per 100 adults (95% CI 7.8 to 8.6), and then plateaued through 2017. The incidence of age-adjusted, diagnosed diabetes did not change significantly from 1980 to 1990, but increased significantly (APC 4.8%) from 1990 to 2007 to 7.8 per 1000 adults (95% CI 6.7 to 9.0), and then decreased significantly (APC −3.1%) to 6.0 (95% CI 4.9 to 7.3) in 2017. The decrease in incidence appears to be driven by non-Hispanic whites with an APC of −5.1% (p=0.002) after 2008.

"We might have mined out a lot of the previously unrecognized cases" and so new diagnoses in the last several years are more likely to be actual new illnesses, said Dr John Buse, a University of North Carolina diabetes expert.

Meanwhile, doctors have increasingly used a newer blood test to diagnoses diabetes. It's much easier than tests that required patients to fast for 12 hours or to undergo repeated blood draws over two hours.

The American Diabetes Association recommended the new test, known as the haemoglobin A1C blood test, for routine screening in 2010. Because it's easier to do, it would be expected to lead to more diagnoses. However, some experts believe this method may miss a large proportion of early cases in which people are not showing symptoms.

"You may be missing people that would have been diagnosed" with older tests, Benoit said.

Another possibility: Increasingly, more doctors have been diagnosing ‘prediabetes’, a health condition in which blood sugar levels are high but not high enough to hit the diabetes threshold. Physicians typically push such patients into exercise programmes and urge them to change their diet.

"Prediabetes is becoming a more accepted diagnosis" and may be causing an increasing number of patients to improve their health before becoming diabetic, said Dr Tannaz Moin, a UCLA expert.

The new report is based on a large national survey conducted by the government every year. Participants were asked if they had been diagnosed with diabetes, and also if the diagnosis was made in the previous year.

It found the rate of new diabetes cases fell to six per 1,000 US adults in 2017, from 9.2 per 1,000 in 2009. That's a 35 percent drop and marks the longest decline since the government started tracking the statistic nearly 40 years ago, according to the CDC.

The decrease was mainly seen among white adults, the researchers said.

Meanwhile, the overall estimate of how many Americans have diabetes - whether the diagnosis is recent or not - has been holding steady at 80 per 1,000 US adults. That translates to about 21 million Americans.

Diabetes has continued to become more common among young adults and people who are black and Hispanic, the report noted.

“In summary, using these national data, we report the longest period of a sustained plateau in prevalence since the 1980s and longest period of declining incidence ever. Although an encouraging sign of success, due to the persistence of major risk factors such as obesity and pre-diabetes, we caution that trends are likely affected by changing awareness, detection, and diagnostic practices,” the authors conclude. “Even in the event of true reductions in incidence, the high prevalence and declining mortality signifies a continued high overall burden of diabetes. For these reasons, we urge a continued emphasis on multilevel, multidisciplinary prevention to reduce both type 2 diabetes and diabetes complications, along with improved surveillance of trends in screening and detection.”

To access this paper, please click here

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