Over the next 40 years, the total prevalence of diabetes in the United States is expected to increase from its current level of about 1 in 10 adults to as many as 1 in 3 by 2050.
The estimate, which includes both diagnosed and undiagnosed diabetes, comes from a new statistical modeling of data from the 2000 Census and the Centers for Disease Control and Prevention. The projected increase in diabetes prevalence is attributed to the aging of the U.S. population, increasing size of higher-risk minority populations, and declining mortality among people with diabetes, said Dr. James P. Boyle and his associates, of the CDC’s Division of Diabetes Translation and Emory University, Atlanta.
“Our estimates of diabetes prevalence paint a sobering picture of the future growth of diabetes. ... The projected loss in quality of life and the projected costs of providing health care could be significant. Increased efforts in primary prevention of diabetes can help to decrease loss in quality of life and the future cost of providing care for people with diabetes,” the investigators said in their paper, published online Oct. 22 in the journal Population Health Metrics.
Previous projections of the prevalence, incidence, and total number of diabetes cases in the United States are outdated because they relied on 1990 census projections, which overestimated current mortality rates and did not account for the increasing size of the Hispanic and foreign-born U.S. populations at higher risk for diabetes. Those projections also did not consider the impact of undiagnosed diabetes on overall prevalence, they noted.
In contrast, the current analysis included 2000 Census–based estimates of the 2007 population and estimates of mortality rates, births, and migration from 2008 through 2050, along with CDC data on diabetes incidence rates among adults aged 18-79 years during 1980-2007.
Models were based on historical incidence of newly diagnosed diabetes per 1,000 persons from 1980 through 2007, with “low” incidence being the 2.5th percentile and “high” incidence defined as the 97.5th percentile. Historically, the incidence of diabetes in the U.S. ranged from 3 cases per 1,000 population in 1980 to 8 per 1,000 in 2007. The “middle incidence” scenario—reflecting recent rate increases—projects an increase of 8 cases per 1,000 in 2008 to 15 cases per 1,000 in 2050.
According to the estimated projection, the prevalence of diagnosed or undiagnosed diabetes would increase from 14% in 2010 to 25% in 2050 under a low incidence/low mortality risk scenario, 21% with low incidence/high mortality, 33% with middle incidence/low mortality risk and 28% for middle incidence/high mortality.
Assuming a hypothetical intervention such as universal lifestyle modification reaching 100% of those at high risk for diabetes (that is, those with impaired fasting glucose), the annual incidence of diabetes would still be reduced only by 25%. “Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population may not eliminate, but might considerably reduce, future increases in diabetes prevalence,” Dr. Boyle and his associates noted.
Projected diabetes increases in the United States reflect the growth of the disease internationally. According to the International Diabetes Federation’s Diabetes Atlas, the prevalence of diabetes will increase from 285 million in 2010 to 438 million in 2030.
The authors declared that they have no competing interests.