Incidence of diagnosed diabetes on the rise in the United States

Diabetes rate nearly doubles in a decade; highest levels seen in the South and Puerto Rico.

The rate of new cases of diagnosed diabetes has risen by greater than 90% among adults during the last 10 years.

Data from 33 U.S. states showed that in the past decade the incidence of diabetes increased from 4.8 per 1,000 people during 1995-1997 to 9.1 per 1,000 in 2005-2007. Incidence rates were higher for the later time frame in 27 out of 33 states (P<.05). The data were published in Morbidity and Mortality Weekly Report.

“This dramatic increase in the number of people with diabetes highlights the increasing burden of diabetes across the country,” Karen A. Kirtland, PhD, a data analyst with the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion at the CDC, said in a press release. “This study demonstrates that we must continue to promote effective diabetes prevention efforts that include lifestyle interventions for people at risk for diabetes. Changes such as weight loss combined with moderate physical activity are important steps that individuals can take to reduce their risk for developing diabetes.”

Geographical increases

Kirtland and colleagues used data from the CDC’s Behavioral Risk Factor Surveillance System to assess the geographic distribution of diagnosed diabetes and to examine state-specific rates. Thirty-three states had data for both periods; 40 states, Washington, D.C. and two territories collected data from 2005-2007. Incidence was age-adjusted using the 2000 U.S. standard population and the researchers analyzed by state, territory and U.S. Census region.

Findings showed that state-specific, age-adjusted incidence of diabetes ranged from 5 per 1,000 people in Minnesota (95% CI, 3.6-6.3) to 12.8 per 1,000 people in Puerto Rico (95% CI, 10-15.5), according to the report. Furthermore, data from 2005-2007 showed that California (n=208,000), Texas (n=156,000) and Florida (n=139,000) had the greatest number of annual new cases.

States with the highest age-adjusted incidence were predominately located in the South, specifically Alabama, Florida, Georgia, Kentucky, Louisiana, South Carolina, Tennessee, Texas and West Virginia. By Census region, average age-adjusted incidence was 10.5 per 1,000 people in the South (95% CI, 9.9-11.1), 8.6 per 1,000 people in the Northeast (95% CI, 7.8-9.4), 8.5 per 1,000 people in the West (95% CI, 7.7-9.3) and 7.4 per 1,000 people in the Midwest (95% CI, 6.6-8.2), according to the report.

“This report documents the geographic distribution of new cases of diabetes and is consistent with previous studies showing an increase in new diabetes cases,” Kirtland said. “We must step up efforts to prevent and control diabetes, particularly in the southern U.S. region where we see higher rates of diabetes, obesity and physical inactivity.” – by Tara Grassia

MMWR Morb Mortal Wkly Rep. 2008;57:1169-1172.

These statistics confirm our worst fears regarding the epidemic of type 2 diabetes. There is little that the individual clinician can do to stem the tide. It is even beyond a public health issue and this epidemic demands government action. The cost of the epidemic will, because of diabetic complications, escalate exponentially and in the end may well bankrupt the system. Interventions to improve lifestyle, to diagnose and to treat diabetes at the earliest possible stage, as well as aggressive and early therapy of established diabetes, can significantly decrease both the morbidity and the cost of diabetes.

– David S. H. Bell, MB, FACE

Endocrine Today Editorial Board member

The rising epidemic of type 2 diabetes in this state-by-state analysis parallels the incidence of obesity in these regions of the United States. Modest weight loss and increasing physical activity represent modifiable risk factors that we should target in reducing our patients’ risk of developing type 2 diabetes.

– Samira Kirmiz, MD

Fellows Advisory Board member