Declines in the Incidence of Diabetes in the USReal Progress or Artifact?

• Type of Material: Article
• Authors: Elizabeth Selvin, Johns Hopkins University; Mohammed K Ali, Emory University
• Language: English
• Date: 2017-09-01
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2017 by the American Diabetes Association.
• License: Creative Commons Attribution-NoDerivs-NonCommercial 1.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.2337/dc16-2442
• Title of Journal or Parent Work: Diabetes Care
• ISSN: 0149-5992
• Volume: 40
• Issue: 9
• Start Page: 1139
• End Page: 1143
• Grant/Funding Information: E.S. is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (K24-DK-106414, R01-DK-089174, and R01-DK-108784).; M.K.A. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (P30-DK-111024).
• Keywords: NATIONAL-HEALTH; UNITED-STATES; TRENDS; Science & Technology; Endocrinology & Metabolism; Life Sciences & Biomedicine; ADULTS; PREVALENCE
• Research Categories: Health Sciences, Public Health

Abstract

National surveillance data show a sustained decline in the incidence rate of diagnosed diabetes, which has been heralded as a success in the battle against diabetes in the U.S. In this Perspective, we take a closer look at these data and provide additional insights to help interpret these trends. We examine multiple sources of data on the prevalence and incidence of diabetes in the U.S. as well as data on trends in diabetes risk factors to provide context for these national surveillance findings. Although some of the incidence decline may represent real progress against diabetes, it is likely that there are also nonbiological factors at play, especially changes in diagnostic criteria for diabetes.We present and discuss data that suggest improved detection and changes in screening and diagnostic practices may have resulted in the depletion of the "susceptible population." Providing this context for the recent declines in new diabetes diagnoses observed in national data is critical to help avoid misinterpretation. We argue that it is premature to declare victory against the epidemic of diabetes in the U.S. and discuss how we might better focus current public health efforts, including a specific emphasis to address prediabetes.