|
 Screening seems to be catching more cases, accounting for the
general rise over two decades, the study authors say, but mainly
whites have benefited; for Hispanic and Asian people in particular,
more than half of cases go undetected.
“We need to better educate people on the risk factors for diabetes –
including older age, family history and obesity – and improve
screening for those at high risk,” lead study author Andy Menke, an
epidemiologist at Social and Scientific Systems in Silver Spring,
Maryland, said by email.
Globally, about one in nine adults has diagnosed diabetes, and the
disease will be the seventh leading cause of death by 2030,
according to the World Health Organization.
Most of these people have Type 2, or adult-onset, diabetes, which
happens when the body can't properly use or make enough of the
hormone insulin to convert blood sugar into energy. Left untreated,
diabetes can lead to nerve damage, amputations, blindness, heart
disease and strokes.
Average blood sugar levels over the course of several months can be
estimated by measuring changes to the hemoglobin molecule in red
blood cells. The hemoglobin A1c test measures the percentage of
hemoglobin – the protein in red blood cells that carries oxygen –
that is coated with sugar, with readings of 6.5 percent or above
signaling diabetes.
People with A1c levels between 5.7 percent and 6.4 percent aren’t
diabetic, but because this is considered elevated it is sometimes
called “pre-diabetes” and considered a risk factor for going on to
develop full-blown diabetes.
Menke and colleagues estimated the prevalence of diabetes and
pre-diabetes using data from the National Health and Nutrition
Examination Survey (NHANES) collected on 2,781 adults in 2011 to
2012 and an additional 23,634 adults from 1988 to 2010.
While the prevalence of diabetes increased over time in the overall
population, gains were more pronounced among racial and ethnic
minorities, the study found.
About 11 percent of white people have diabetes, the researchers
calculated, compared with 22 percent of non-Hispanic black
participants, 21 percent of Asians and 23 percent of Hispanics.
Among Asians, 51 percent of those with diabetes were unaware of it,
and the same was true for 49 percent of Hispanic people with the
condition.
An additional 38 percent of adults fell into the pre-diabetes
category. Added to the prevalence of diabetes, that means more than
half of the U.S. population has diabetes or is at increased risk for
it, the authors point out.
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The good news, however, is fewer people are undiagnosed than in the
past, Dr. William Herman and Dr. Amy Rothberg of the University of
Michigan in Ann Arbor note in commentary accompanying the study in
JAMA.
In it, they note that the increase in diabetes prevalence between
1988 and 2012 seen in the study was due to an increase in diagnosed
cases, and that overall undiagnosed cases fell from 40 percent in
1988-1994 to 31 percent in 2008-2012.
This “likely reflects increased awareness of the problem of
undiagnosed diabetes and increased testing,” they told Reuters
Health by email.
The drop in undiagnosed cases, they added, may be due in part to the
newer, simpler A1c test, which doesn't require fasting or any
advance preparation.
It’s also possible that new cases of diabetes are starting to fall
for the first time in decades because more people are getting the
message about lifestyle choices that can contribute to diabetes,
noted Dr. David Nathan, director of the diabetes center at
Massachusetts General Hospital in Boston and a professor at Harvard
Medical School.
In particular, more patients now understand that being overweight or
obese increases the risk for diabetes, Nathan, author of a separate
report in JAMA on advances in diagnosis and treatment, said by
email.
“Behavioral changes, including healthy eating and more activity can
prevent, or at least ameliorate, the diabetes epidemic,” Nathan
said.
SOURCE: http://bit.ly/1IWnTLH , http://bit.ly/1Ob6W7c and http://bit.ly/1QmAn5o
JAMA, online September 8, 2015.
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