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Rate of new diabetes cases may be falling globally
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Recent studies suggest the rate at which new diabetes cases develop, or diabetes incidence, may be falling, despite a rising diabetes prevalence globally, according to study data presented at the European Association for the Study of Diabetes annual meeting.
“After decades of increasing diabetes incidence, we are finally starting to see some clues that point to patterns of decreasing diabetes incidence,” Dianna J. Magliano, PhD, MPH, a senior research fellow with the National Health and Medical Research Council and head of the diabetes and population health unit at the Baker Heart and Diabetes Institute in Melbourne, Australia, told Endocrine Today. “The most obvious conclusion that can be drawn from falling incidence is that we may be succeeding in reducing the risk for developing diabetes in the population.”
Magliano and colleagues analyzed data from 275 studies conducted between 1980 and 2018 with at least 2 years of follow-up that reported the incidence of diabetes or type 2 diabetes in adults. Studies were stratified by five time periods (1970-1979, 1980-1989, 1990-1999, 2000-2009, and 2010 and later). Researchers used negative binomial regression analysis to model diabetes incidence by age group, adjusted for midpoint of baseline year, race and method used in diabetes diagnosis at follow-up.
Researchers found that the overall crude annualized diabetes incidence rose from 0.53% in the 1970s to 1% in the years after 2010.
Compared with individuals aged 35 years and younger, the incidence rate for diabetes approximately doubled for individuals aged 35 to 44 years (incidence rate ratio [IRR] = 1.8; 95% CI, 1.3-2.6), tripled for individuals aged 55 to 64 years (IRR =2.9; 95% CI, 2.1-4.1) and increased 3.5 times among adults aged at least 65 years (IRR = 3.6; 95% CI, 2.5-5.2).
In a press release, the researchers noted that, compared with studies with a midpoint of baseline year in 1990s, the incidence rate was 20% higher in studies with a midpoint between 2000 and 2009 (IRR = 1.2; 95% CI, 1.02-1.41). However, when looking at studies conducted from 2010 onward, researchers observed a 5% decrease in diabetes incidence that did not reach statistical significance (IRR = 0.95; 95% CI, 0.63-1.45).
“The incidence of diabetes progressively increased from studies beginning in the 1970s to those beginning in the early 2000s,” the researchers wrote in a poster presentation. “The highest rate of incidence was observed in studies that began around the year 2000. Studies that began after 2003 suggested the incidence started to decline.”
Additionally, compared with studies with mostly Europeans, diabetes incidence was higher for studies with adults of African, Asian, Hispanic and indigenous descent (P < .014 for all). Diabetes incidence was also higher in studies that used fasting glucose and/or a 2-hour oral glucose tolerance test for diagnosing diabetes at follow-up compared with studies that did not report on the method of diagnosis used (P = .003).
“The introduction of HbA1c testing is unlikely to be responsible for these trends, as we adjusted for diagnostic test,” the researchers wrote in their poster. “Furthermore, very few studies relied on HbA1c alone for diagnosing diabetes.”
The researchers noted that the downturn in incidence may be partially due to successful public health campaigns to prevent diabetes.
“These findings suggest that we may be seeing the benefits of diabetes prevention and healthy lifestyle awareness, which has taken place globally,” Magliano told Endocrine Today. “However, while we can be optimistic, we do still need to be cautious, and this work does not mean we can stop these prevention activities. We want the community to continue to work towards the goal of a healthy lifestyle and don’t want people or communities to become complacent. It should be noted that our data was mainly from high-income countries, and patterns of incidence in other countries may indeed be different.”– by Regina Schaffer
Reference:
Magliano DJ, et al. Abstract 315. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.
Disclosures: The authors report no relevant financial disclosures.