Fewer People Are Getting Diabetes, But The Epidemic Isn't Over

Dec 1, 2015
Originally published on December 4, 2015 1:10 pm

The number of people newly diagnosed with diabetes continues to decline after decades of increases that transformed what was once a disease of the old into a public health crisis that affects even children.

That's not to say the crisis is over; 1.4 million people were diagnosed with diabetes in 2014, according to numbers released Tuesday by the Centers for Disease Control and Prevention. That's down from 1.7 million new cases in 2009, the fifth straight year of decline.

The numbers are going in the right direction, says Ann Albright, director of the CDC's Division of Diabetes Translation, "but we still have a long, long way to go."

Indeed, the number of new cases each year is still triple what it was in 1980. And 29 million people, 9 percent of the U.S. population, have diabetes. Black and Hispanic people continue to be far more vulnerable. The number of new cases showed no consistent change among Hispanics from 2009 to 2014, and didn't change significantly among blacks.

Diabetes increases a person's risk of heart attack, stroke and blindness, as well as nerve damage and circulatory problems that can lead to amputation.

"It's not like we've beaten the epidemic, but it's the first good news we've had in several decades," says Dr. David Nathan, a diabetes researcher at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. He's hopeful that if the trend continues, eventually the number of people with diabetes will start to decline, too.

The CDC data come from a national survey that lumps together Type 1 and Type 2 diabetes, even though they are very different. Type 1 is an autoimmune disorder that is usually diagnosed in childhood and is not affected by obesity. Type 2 is typically diagnosed in older people, and obesity and a sedentary lifestyle are key risk factors. It is much more common than Type 1, accounting for 95 percent of diabetes.

The big question, of course, is why the numbers are finally looking up.

Albright credits efforts like the National Institute's of Health's Diabetes Prevention Program, which showed that losing a modest amount of weight and getting more exercise sharply reduces the risk of developing diabetes in people at high risk. The studies were finished over a decade ago, enough time for the word to get out to doctors and the public, Albright says.

People are also more aware of the importance of healthful food, Albright says, and are starting to turn away from sodas and junk food. "We need to marshal our energy, our communities, in support of those healthy choices," she says.

Targeting people at high risk has helped, says Nathan, who was a leader of the Diabetes Prevention Program studies. "It's hard to argue that increasing activity levels and decreasing weight wouldn't be good for everyone, but for those programs to be efficient you've got to target high-risk people," Nathan says. With programs to test people and treat those considered to have prediabetes, "We now know we can do that."

The nation's rising rate of obesity appears to have plateaued, but it's not declining the way new diabetes diagnoses are, notes Dr. George King, chief scientific officer for the Joslin Diabetes Center in Boston. "This is a big change," King says. "That means that something is changing faster than the obesity rate. Activity, sleep patterns, processed food — it's probably a combination of all these things."

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There's good news today from the Centers for Disease Control and Prevention. Diabetes is still on the decline. One-point-four million new cases were reported in 2014. That's according to data released today. And it's down from a high of 1.7 million new cases six years ago. A downturn is good news, but the number of new cases is still nearly triple what it was in 1980. To help us understand what's behind these numbers, we're joined now by Ann Albright. She is director of the CDC's Division of Diabetes Translation, which means that her team works to translate science into daily practice. Welcome to the program.

ANN ALBRIGHT: Thank you.

SIEGEL: What should we make of these numbers? Are they an indication that Americans are eating better, exercising more? What would you say?

ALBRIGHT: Well, I think there are number of factors that are occurring. We are seeing more people who are adopting healthy lifestyles. For the last five years or so, the CDC has been working with a number of partners around the country to implement the National Diabetes Prevention Program. And that is a structured lifestyle program that has been shown to prevent or delay Type 2 diabetes in those at high risk. It's actually the intervention that has the most evidence behind it. We're also seeing changes in some of the larger issues like food and access to food and people making choices. We're seeing more opportunities for people to decrease their soda intake and to be getting more physical activity.

SIEGEL: You said people are having more opportunities to reduce their soft drink consumption. That's different from them reducing their soft drink consumption, though.

ALBRIGHT: Well, I think we're certainly seeing that that's happening, but you know, in order for people to take action, they need to really have opportunities around them. It needs to be easier for them to do these things.

SIEGEL: The bar graph that I looked at that shows new cases of diabetes each year since 1980 - it's very remarkable. It shows that throughout the '80s, the level was pretty stable, starts rising in the 1990s. And then around 2008, it really shoots up. Do you understand why that was, what was happening that would drive up the number of cases so quickly?

ALBRIGHT: Well, there are a few things, again, going on. The diagnostic criteria for diabetes has been revised over time, and that's an important thing to point out. We have lowered the diagnostic criteria for diabetes because we are seeing that there are indeed complications and problems associated with diabetes at these new diagnostic rates.

SIEGEL: Are you saying that part of what happened between, say, 1980 and 2008 was that more people who were diabetic were likely to be diagnosed as diabetic at the end of that period than at the beginning?

ALBRIGHT: That's right.

SIEGEL: I guess that makes the current decline all the more remarkable. It's...

ALBRIGHT: That's right. That's exact the right because we are using that criteria that some would say has included more people in this category of diabetes. So you're right. The fact that we're seeing a decline does make it even more important and more highlighted.

SIEGEL: Does five years establish a trend in your mind? Does that show you something's really happening, or could it tip back up again and...

ALBRIGHT: Well, it does show us a trend and an important trend. But at any time, a trend can tip back up. And so it's important for us to really put our shoulder into the prevention efforts that are going on around the country, things that, again, improve the environments people are living in, more safe places to be physically active, more access to healthy food options. And whatever new discoveries we make through our science in the coming years have got to move from the science into practice. Otherwise, we never have an impact on the public's health.

SIEGEL: Ann Albright, thanks for talking with us today.

ALBRIGHT: Thanks so much.

SIEGEL: Ann Albright works on reducing diabetes at the Centers for Disease Control and Prevention in Atlanta. Transcript provided by NPR, Copyright NPR.