Rising Diabetes Rates: A Silver Lining?

Mark Harmel, MPH; Elizabeth Selvin, PhD


May 22, 2014

Editor's Note: A recent analysis based on National Health and Nutrition Examination Survey (NHANES) data, published in the April 15 issue of the Annals of Internal Medicine,[1] contained some good news for once. At the same time that the prevalence of diabetes has increased over the past 2 decades, screening and treatment also have improved. Medscape talked with Elizabeth Selvin, PhD, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, to learn more about the challenges of comparing data over time and the remaining health disparities in minority communities. She also gave us the inside story on NHANES data and what areas require more research.

Medscape: The bad news is that the prevalence of diabetes has increased substantially, from about 6% of US adults in 1988 to almost 10% in 2010. However, there is good news to report as well about screening and diagnosis.

Dr. Selvin: Yes, I agree that not all the news is bad. Despite the large increases in cases of diabetes overall, we found that most cases of diabetes are being diagnosed. Only 11% of cases of diabetes in the United States remain undiagnosed, so that suggests that we are doing a good job with screening and diagnosis.

Medscape: It seems that rates of prediabetes are leveling off as well. What do you find interesting in those data?

Dr. Selvin: The prediabetes trends are interesting. We saw a big increase in prediabetes from the 1980s and 1990s to the 2000s. That was also when large increases in obesity rates occurred, and the recent leveling off of prediabetes rates is also tracking with the leveling off of the obesity epidemic. These findings reflect diagnostic trends of identifying people with high glucose levels and high glycated hemoglobin (A1c) levels, and we need to pay attention to that particular group.

Medscape: Do you also see improvements in treating diabetes to target?

Dr. Selvin: Yes, we definitely saw major improvements in people reaching target levels of glucose control and lower A1c levels overall in the population. This suggests that we are identifying people earlier in the disease process and doing a better job with treatment, and it indicates the effectiveness of the newer glucose medications.

Medscape: Despite the improvements, there are troubling signs in black and Mexican American populations. What are some of the issues in these groups?

Dr. Selvin: It's true that we found major disparities in who is affected by diabetes. We found a higher prevalence of diabetes -- especially undiagnosed diabetes -- in black and Mexican-American populations compared with white populations. We also saw that black and Mexican-American patients who were diagnosed with diabetes had a higher prevalence of poor glucose control.

The racial disparities in the burden of diabetes and prediabetes are especially sobering. Ethnic minority groups are at high risk for complications of diabetes, and it speaks to the need for efforts that particularly target those groups. It really suggests that we need to work with minority communities to help raise awareness of diabetes and target our prevention efforts in this population.

Medscape: Increasingly, the burden of the disease falls on older adults. You suggest the need for national efforts to address this population as it expands. What did you have in mind?

Dr. Selvin: Diabetes in the elderly is a huge issue. The prevalence is high, and we really don't have a good understanding of the disease in older adults. The current treatment recommendations do not distinguish well between older and younger individuals, and treating elderly people with diabetes can be quite complicated.

For example, we might see a 70-year-old person who is very healthy, runs 2 miles every day, and has a long life expectancy. We might want to treat that person very differently from a 70-year-old who is frail, takes many different medications, and has different clinical needs. The diversity of the elderly population is a particular challenge. We need to devote more resources and research dollars to understanding the disease in older adults and figuring out the best treatment options in this population.


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