Pre-Diabetes and Diabetes Nearly Double in Past Two Decades

Cases of diabetes and pre-diabetes in the United States have nearly doubled since 1988, suggests new research from the Johns Hopkins Bloomberg School of Public Health, with obesity apparently to blame for the surge. The researchers also found that the burden of the disease has not hit all groups equally, with alarming increases in diabetes in blacks, Hispanics and the elderly.

According to new research reported in the April 15, 2014 issue of the Annals of Internal Medicine, diabetes increased from 6 percent to 10 percent in the past two decades and pre-diabetes also doubled in prevalence over the same period. Depending on the definition used, current estimates of the prevalence of pre-diabetes range from 12 percent to 30 percent in the population. “There is a growing need to recognize this serious issue, especially since most cases of diabetes can be prevented through weight loss and other lifestyle changes,” said lead author, Elizabeth Selvin, PhD, MPH, an Associate Professor at the Johns Hopkins Bloomberg School of Public Health.

In 2010, approximately 21 million American adults aged 20 or older had confirmed diabetes (either diagnosed or undiagnosed). The investigators analyzed data from more than 43,000 participants collected over two decades in the National Health and Nutrition Examination Surveys (NHANES). Selvin and her fellow investigators set out to update national trends in pre-diabetes, diabetes and its treatment based on data from the NHANES.

One novel aspect of this study was to “confirm” cases of undiagnosed diabetes in the population. Previous studies of diabetes prevalence have relied on single tests of glucose to identify undiagnosed cases of diabetes in the population. But in reality, glucose tests would be confirmed by a second test in the doctor’s office. The investigators used a second measure, HbA1c, a lab test that measures glucose over the past three months, to confirm all cases of undiagnosed diabetes in their study to give the most realistic estimate of the burden of the condition in the population.

While diabetes has increased dramatically in the population, the investigators found that the proportion of cases of diabetes that are undiagnosed has decreased. Currently, only 11% of diabetes cases in the U.S. population are undiagnosed, suggesting major improvements in screening and diagnosis of diabetes during the last two decades.

However, major challenges still exist despite improvements in screening and treatment for diabetes. The investigators found a greater prevalence of pre-diabetes and diabetes, particularly undiagnosed diabetes, in ethnic minorities compared with whites. This disparity has increased over the past 20 years. “The substantially greater prevalence of pre-diabetes and diabetes, and poor rates of glycemic control (even among persons with medication-treated diabetes) in ethnic minority populations is particularly concerning,” Selvin said. “Especially since blacks and Mexican Americans are also at a greater risk for complications of diabetes.”

Total diabetes in blacks was nearly double the prevalence in whites (15% vs. 9%). Mexican Americans also had a greater prevalence of diabetes than whites (12% vs. 9%). Racial and ethnic differences also existed in treatment of diabetes and glycemic control. Among persons diagnosed with diabetes who reported currently taking medications, only 52% of non-Hispanic blacks and 43% of Mexican Americans had HbA1c levels less than 7.0% compared with 57% of non-Hispanic whites.

“The implications of the increase in pre-diabetes and diabetes are enormous but the good news is we are doing better with screening and diagnosis,” says Selvin.

The study was funded by the National Institutes of Health.

“Trends in Prevalence and Control of Diabetes in the United States, 1988–1994 and 1999–2010” was written by Elizabeth Selvin, PhD, MPH; Christina M. Parrinello, MPH; David B. Sacks, MB, ChB; and Josef Coresh, MD, PhD.


The material in this press release comes from the originating research organization. Content may be edited for style and length. Have a question? Let us know.


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5 thoughts on “Pre-Diabetes and Diabetes Nearly Double in Past Two Decades”

  1. The increase in diabetes throughout the past few decades can, in most cases, be linked to the abuse of one’s body through eating the wrong foods and the lack of exercise. I feel that in most cases diabetes (Type II) is a reversible condition and can be addressed through the bettering of one’s lifestyle. Fast foods, sugary foods, and other unhealthy foods can be replaced with fresh and healthy foods which are low in sugar, unhealthy fats, and are not processed. Exercise is a key component to long-lasting good health, and does not necessarily have to be performed in an excessive manner but ensuring that you get a minimum amount of exercise every day is key to health.

  2. Over the past two decades, in modern society, diabetes has become highly prevalent. This is owing to the change in lifestyle activities, as the stresses from one’s daily life, have taken preference. It is mentioned above, that diabetes is more common amoungst “blacks, Hispanics and the elderly.” This is due to their cultural and lifestyle differences. Many non-European cultures have large traditions where the meals have are prepared with a higher fat and sugar content. This leads to the prevalence rate, in these ethnic groups, being higher. The elderly do not move as much as an average adult as their body becomes highly fragile, this leads to diabetes, as the intake of sugar and fat is not being metabolized correctly.

    However, in modern society where technology is rapidly increasing faster than one can blink, technological devices are being developed to make our lives easier. This means majority of adults, who age from 20 years of age and onwards, are becoming less active due to these technological devices as a lot of work and activities require less effort than they used to previously.

    Research has shown that scientists have developed a method called HbA1c, which is used for screening of undiagnosed diabetes. This method is highly effective as it makes patients aware of their diagnosis and forces them to take better care of themselves, as well as this method is able to detect diabetes from the past three months of diagnosis which aids in the patients being aware of the seriousness of their status. I believe that the public needs to be educated on the seriousness of diabetes and the problems it can lead to when not monitored regularly, because majority of diagnosed patients that are ‘medically-treated’ have poor glycemic control.

  3. Diabetes is an epidemic. The condition is nearly four times as common as all forms of cancer combined.

    There are three known types of diabetes:
    Type 1, where the body does not produce insulin.
    Type 2, where the body does not produce enough insulin, or the body can’t use the insulin that the body produces.
    Type 3 is a type that women sometimes develop during pregnancy.

    The main cause of diabets is an unhealthy lifestyle. Eating unhealthy, drinking too much alcohol and not excersizing enough is known as the main factors that causes diabetes- however, a person can also be born with diabetes.

    All types of diabets can be treated. Type 1 is normally treated with daily insulin injections, whilst Type 2 is usually treated by means of tablets. Both of them however is also treated by means of a healthy diet and exercise.

    The conclusion I make is that, just by watching your weight, eating healthy and exercizing regularly, you can decrease your chance of developing diabetes.

    Thus, we should all try to live healthier lives and inform people about the fact that we can decrease the chance of developing diabetes by living healthy.

  4. Most people find it difficult to maintain a healthy lifestyle and diet whilst having to deal with social, personal and work related issues. As a result, diabetes has become a major health risk in our modern society. Because our world has become so technologically advanced, we are able to do things and perform many functions without much effort and movement. As a result, we have become lazy and less concerned with exercise and health. Our genetics also play a role in our susceptibility to illnesses such as diabetes, which may also explain why there is a higher prevalence of diabetes amongst people of different ethnicities/races. Diabetes may arise due to genetics, but I believe that most cases of diabetes arise due to an unhealthy lifestyle and diet. It is difficult to get people to change to a healthier lifestyle once they become accustomed to a certain daily routine. Implementing weight loss and special dietary food programmes to reduce the risk of diabetes is also expensive and requires considerable self control. Unless we contemplate new, efficient ways to decrease our chances of becoming diabetic, diabetes will continue to remain a major health risk in our modern world.

  5. Due to personal experience I know that diabetic is because of an unhealthy lifestyle or a a trauma if one is not born as a diabetic. Today our world is full of crime and that causes more trauma than always. Time also became an issue and that lead to an unhealthy lifestyle. People eat more fast food and that contains more sugar and bad fat which will increase cholestrol and diabetics.


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