In the United States (US), the prevalence of type 2 diabetes (T2D) almost doubled between 1988 and 2018 when gender, ethnicity, and subtypes of the disease were factored into the number. These findings were published in the Journal of Clinical Endocrinology & Metabolism.

Data were sourced from National Health and Nutrition Examination Surveys (NHANES) conducted by the Centers from Disease Control and Prevention. Trends in T2D and its various subtypes were assessed between 1988 and 2018.

Complete clinical and biochemical data were available for 5489 individuals aged mean 61.2±14.3 years, 51.2% were men, and 44.3% were White.


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The prevalence of T2D has increased steadily from 7.5% in 1988-1989 to 13.9% in 2016-2018 (P <.001).

Stratified by T2D subtype, mild obesity-related diabetes (MOD) showed the greatest increase over time, followed by mild age-related diabetes (MARD) and severe-insulin deficient diabetes (SIDD). Severe-insulin resistant diabetes (SIRD) also increased, but the change was not considered significant. Severe-autoimmune diabetes (SAID) remained stable over a 6-year period (1988-1991) included in the NHANES-III period in which its prevalence could be assessed.

Type 2 diabetes increased more rapidly among men than women. Both MOD and MARD increased among both men and women, but SIDD increased only among men over time.

Blacks and Mexican Americans showed the highest prevalence of T2D over the study period compared with Whites. For Blacks, MOD, SIDD, and SIRD subtypes increased the most; for Mexican Americans, MOD and SIDD increased the most; and for Whites, MOD and MARD rates showed the greatest increase during the study period.

Adults with obesity had the highest prevalence of T2D compared with people who were considered normal weight or overweight. MARD rates increased among all categories, regardless of body mass index (BMI).

The criteria for the definition of T2D varied during the study period, the researchers acknowledged, which may have affected their conclusions. Other limitations such as the nature of cross-sectional surveys were also noted as potential limitations.

“Obesity is an essential determinant of the increases in [T2D] prevalence over time, however, our results suggest that this is true primarily for MOD and SIRD, but not MARD nor SIDD,” the researchers concluded. “This expansion in [T2D] heterogeneity and subgroup prevalence over time is likely attributable to multifactorial causes, including but not restricted to increasing obesity rates, population aging, socioeconomic disparities, and lifestyle, which should be addressed longitudinally to inform public policy.”

Reference

Antonio-Villa NE, Fernández-Chirino L, Vargas-Vázquez A, Fermín-Martinez CA, Aguilar-Salinas CA, Bello-Chavolla OY. Prevalence trends of diabetes subgroups in the US: A data-driven analysis spanning three decades from NHANES (1988-2018). J Clin Endocrinol Metab. 2021;dgab762. doi:10.1210/clinem/dgab762