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Diabetes epidemic

One in ten (or 21 million) US adults are diabetic

Rates of diabetes increase with obesity rates
Rates of pre-diabetes also increased over the study period

One in ten US adults as diabetes with the percentage of diabetic Americans doubling since 1988, according to a study by researchers from Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. They found that in the late 1980s and early 1990s, the rate of diagnosed and undiagnosed diabetes was 5.5 percent of the US population. By 2010, that number had risen to 9.3 percent, equating to approximately 21 million American adults.

Despite the number of diabetics almost doubling in 20 years, there were several encouraging findings that emerged from the study; they found that a smaller proportion of people have undiagnosed diabetes suggesting that newer screening techniques may be more efficient.

In addition, the study 'Trends in Prevalence and Control of Diabetes in the United States, 1988–1994 and 1999–2010' published in the Annals of Internal Medicine, also reported that overall blood sugar control was improved, although the disease was less well controlled in some minority groups.

Dr Elizabeth Selvin

“Diabetes has increased dramatically,” said Dr Elizabeth Selvin, the study's lead author and an associate professor of epidemiology at the Johns Hopkins. “The rates have almost doubled since the late '80s and early '90s. This study also highlights that the increase in diabetes really tracks closely with the epidemic of obesity. The diabetes epidemic is really a direct consequence of the rise in obesity.”

Type 2 diabetes is the far more prevalent type of diabetes, accounting for 90-95 percent of all diabetes, according to the National Diabetes Education Program.

For the new study, the researchers used data from the National Health and Nutrition Examination Survey (NHANES), which included more than 43,000 adults followed from the first survey period (1988 to 1994) to the most recent (1999 to 2010).

In 1988 to 1994, the prevalence of diagnosed diabetes was 5.5 percent and by the next survey in 1999 to 2004, that number had risen to 7.6 percent. In the final survey, performed from 2005 to 2010, the prevalence of diagnosed diabetes was 9.3 percent.

During that same time period, levels of obesity also rose. For people without diabetes, obesity rates rose from about 21 percent in the first survey to over 32 percent in the last. In those with diabetes, nearly 44 percent were obese during the first survey. That number rose to about 61 percent in the most recent survey.

Rates of pre-diabetes also increased dramatically from less than 6 percent to more than 12 percent over the study period. However, the number of people with undiagnosed diabetes levelled off during the study period, likely due to improved screening methods.

Overall, the number of people with undiagnosed diabetes was reduced to 11 percent by 2010, according to the study.

"The reality is that we know what to do to prevent type 2 diabetes, but doing it on a population level is an incredible challenge," added Selvin. "There's some evidence that the obesity epidemic may have plateaued, but combating the environment that contributes to obesity is an incredible difficulty."

Dr Martin Abrahamson, senior vice president for medical affairs at the Joslin Diabetes Center, in Boston, is a co-author of an accompanying editorial in the same issue of the journal.

“This article is a reminder that this problem isn't going away; it's only getting worse,” said Abrahamson. “There are too many pushes and pulls in society that make it difficult for people to adhere to lifestyle regimens. Adhering to a healthy diet and exercising regularly have all shown benefit in reducing diabetes, hypertension, weight and cholesterol.

"So, how do you get people to embrace lifestyle changes?" he added. "It's really going to take a multipronged effort that requires private and public institutions to really come together and develop a strategy to advance the message to live a healthy life. We also need to engage health-care professionals in doing a better job in counselling the benefits of lifestyle changes.”

Both Selvin and Abrahamson said the finding that overall blood sugar control has improved among whites, but not among minorities, suggests that more public health dollars - for prevention, raising awareness and increasing access to care - need to be targeted to minority communities.

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