New US Diabetes Prevalence Data Distinguish by Disease Type

Diana Phillips

March 30, 2018

Approximately 23 million adults in the United States are living with diabetes, and of these, nearly 6% have type 1 disease, according to new surveillance data from the Centers for Disease Control and Prevention (CDC).

Unlike previous estimates that did not distinguish between types of diabetes, the new estimates are based on data collected in the 2016 National Health Interview Survey, which included supplemental questions to help classify diabetes by disease type, report Kai McKeever Bullard, PhD, from the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, and colleagues. The study, published March 30 in the Morbidity and Mortality Weekly Report, is the first to estimate the prevalence of diagnosed type 1 and type 2 diabetes according to self-report and current insulin use among US adults.

The ability to estimate diabetes prevalence by disease type is important, the authors stress, because it allows for more accurate monitoring of trends and targeted planning and prioritization of public health responses.

The nationally representative 2016 National Health Interview Survey sample consisted of 33,028 adults aged 18 years or older, with a final response rate of 54.3%. Of these, 3519 respondents self-reported diabetes, including 2897 with type 2 diabetes and 211 with type 1 diabetes. An additional 98 cases were classified as "other" type, such as maturity-onset diabetes of the young or latent autoimmune diabetes in adults, and 1 was classified as unknown, the authors report.

The respective prevalence rates for type 1 diabetes, type 2 diabetes, and other forms of the disease were 0.55%, 8.58%, and 0.31%.

"Based on the weighted [National Health Interview Survey] population, the estimated numbers of adults with type 1, type 2, and other diabetes types were 1.3 million, 21.0 million, and 0.8 million, respectively," the authors write. They note, however, that prevalence rates varied by age, sex, and race/ethnicity, depending on the disease type.

For type 1 diabetes, the prevalence was significantly higher among men (0.64%) than among women (0.46%; P < .05). It was also higher among non-Hispanic whites (0.67%) than among Hispanics (0.22%; P < .01). Significant differences were observed in the prevalence of type 2 diabetes among non-Hispanic blacks (11.52%), non-Hispanic Asians (6.89%), non-Hispanic whites (7.99%), and Hispanics (9.07%; P < .001).

Further, type 2 disease was most prevalent in adults 65 years and older and least prevalent in those aged from 18 to 29 years (P < .001). Prevalence decreased with higher levels of education (P < .001).

The observed variations in prevalence of type 1 and type 2 diabetes are notable from a surveillance perspective, according to the authors.

"Because the prevalence of type 2 diabetes is so much higher than that of type 1, current diabetes surveillance data that do not distinguish diabetes type are more reflective of persons with type 2 diabetes," they state. The etiology, treatment, and outcomes of the disease vary by type, however, so action planning tied to nondifferentiated surveillance data does not meet the needs of the smaller type 1 diabetes population.

Although limited by the reliance on self-reported diagnoses and insulin use, underestimation of total diabetes prevalence, and potential misclassification of diabetes type, the study provides important information for monitoring trends by disease type and creating targeted education and prevention programs, the authors explain. "Knowledge about national prevalences of type 1 and type 2 diabetes might facilitate assessment of the long-term cost-effectiveness of public health interventions and policies aimed at improving diabetes management and help to prioritize national plans for future type-specific health services," they write.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2018;67:359-361. Full text

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