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Diabetes Prevalence Shows No Signs of SlowingPosted: Saturday, June 30, 2007
The prevalence of diabetes of all types in the U.S. has risen by about 5% annually since 1990, keeping pace with the fattening of America, reported CDC investigators.
"The growth in diabetes prevalence and incidence accelerated in the early 1990s and this acceleration remains unabated," said Linda Geiss, M.A., at the American Diabetes Association meeting here.
"It is likely tied to the growth in obesity in this country, and if we are going to stem the growing burden of diabetes, we must improve our prevention efforts," said Geiss. That the prevalence of diabetes is rising is not news, but the pace of the increase is remarkable and disturbing, she said.
But other CDC researchers, in collaboration with the North Carolina Department of Health and Human Services, have developed a community outreach program that may help slow or eventually reverse the trend, at least in one corner of the country.
Desmond E. Williams, M.D., Ph.D., a medical epidemiologist at the CDC, said that the community-based program slowed the growth in the type 2 diabetes rate relative to the general population.
In Geiss study, she and colleagues used National Health Interview Survey data to determine nationally representative age-adjusted prevalence and incidence rates and their standard errors.
They identified three distinct periods in the epidemiology of diabetes:
1963-75, during which prevalence increased from 13.6 to 25.8 per 1,000 people, for an average of 5.1% per year (P for trend <0.01)
1975 -1990, during which prevalence rates remained unchanged (annual relative percent change 0.45, P=0.19)
1990-2005, during which prevalence climbed from 26.4 to 54.5 per 1,000, for an average of 4.6% per year (P<0.01).
Data on trends in diabetes incidence among adults were only available from 1980 onwards, but these were consistent with trends in prevalence for Americans of all ages, Geiss said.
"Using the same data source, we examined weight trends among adults age 20 and over and found that obesity in the U.S. population began to increase at a more rapid rate in 1986, four years prior to the time when diabetes began to increase significantly," she said.
The reasons for the plateau in prevalence from 1975 to 1990 are unknown, but it coincided with the release of the first standard diagnostic criteria for diabetes in 1975. It's possible that the availability of diagnostic guidelines resulted in more consistent diagnosis, Geiss commented.
In the study by Dr. Williams, he and colleagues described how the Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) initiative affected local prevalence.
The project used a combination of outreach programs. They included health promotion, such as a walking program based in churches, community centers, and YMCAs, and a program to educate cooks at church socials about how to reduce fats and salt in foods served at church suppers. They also included workshops about the ADA guidelines for physicians, nurses, physician assistants, and nutritionists for management of diabetes.
The Raleigh, N.C., region was targeted for the intervention. Greensboro, N.C., a community of similar size and demographic, was used as a control.
The authors used pre- and post-intervention surveys conducted in 1996-1997 and 2003-2004 using randomly selected samples of the population ages 18 to 75 to gauge the success of their program.
The program reduced sedentary behavior significantly more over seven years in Raleigh (from 39.4% in 1996-97 to 29.0% in 2003-2004) compared with Greensboro (from 35.3% to 32.7%, respectively, P=0.01).
The number of participants in the intervention community who said they intended to lose weight increased from 76.5% at baseline to 85.4% post intervention, but there was no change among controls (84.3% in 1996-97 to 86.6% in 2003-2004, P for difference between intervention and controls 0.03)
The total diabetes prevalence increased in both communities, but the rate of increase was slower in Raleigh than in Greensboro. In Raleigh prevalence rose from 10.5% in 1996-1997 to 16.7% in 2003-2004. The prevalence in Greensboro increased from 9.3% in 1996-1997 to 18.6% in 2003-2004 (P=0.01).
The changes in both sedentary behavior and total diabetes were significant after the data were adjusted for age, race/ethnicity, and education. There was no change, however, in the obesity prevalence in either community.
"This encourages us to think that we can influence health behaviors in the community, and we can also influence progression of diabetes in the community," said Dr. Williams.
He added, however, that "the diabetes epidemic is like a freight train that shows no signs of slowing down, so I don't think it's realistic for us to expect that we can stop the prevalence of the diabetes epidemic on a dime."
Source: Diabetes In Control: American Diabetes Association 2007 Scientific Sessions : Geiss LS et al. "Long Term Trends in the Prevalence and Incidence of Diagnosed Diabetes." Abstract 0125, presented June 23.
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