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‘Only Gotten Worse Over Time’: CDC Report on Diabetes and Obesity in the US

This transcript has been edited for clarity.

The Centers for Disease Control and Prevention (CDC) has released their most recent data on the rates of diabetes and obesity in the United States which they do every 2 years. These are the rates between 2017 and 2019. Not surprisingly, the data have only shown that we get worse over time.

Some 37.3 million people in the United States now have diabetes, which accounts for 11.3% of the US population. About a quarter of the people with diabetes in the US are undiagnosed. Prediabetes accounts for 38% of the entire US population, and interestingly to me, almost half of the people who are 65 years or older have prediabetes.

As a clinician, I’m not quite sure what to do with that because I certainly have seniors who have slight elevations in their fasting glucose values or A1cs where I don’t really have to do much clinically. What I think that means is that I need to watch those people for the development of overt diabetes and modify their risk factors for cardiovascular disease. Not all of those people are going to go on to have diabetes.

There are 283,000 children and adolescents younger than the age of 20 years who have diabetes. These are mostly individuals with type 1 diabetes, but rates of type 2 diabetes in youth are increasing. There are 1.6 million adults aged 20 years and older who report having type 1 diabetes and using insulin.

Of particular interest to me are the 3.1 million adults in the United States who say they were started on insulin within a year of their diagnosis. Within this group, there are likely many with undiagnosed adult-onset type 1 diabetes. The reason I think this is particularly important is that these individuals may need to be managed with intensive insulin therapy, with insulin pump therapy, with continuous glucose monitoring — the kind of intensive treatment we give to our patients with known type 1 diabetes who may not be getting diagnosed or treated properly.

As we’ve heard before, the prevalence of diagnosed diabetes is highest in American Indians and Alaska Natives, followed by non-Hispanic Blacks, then people of Hispanic origin, non-Hispanic Asians, and finally, non-Hispanic Whites.

The prevalence of diabetes varies significantly by education level, which is an indicator of socioeconomic status. For frame of reference, 13.4% of adults with less than a high school education were diagnosed with diabetes compared with only 7.1% of those who have more than a high school education. Families with an income below the federal poverty level had the highest prevalence of diabetes for both men and women.

In terms of rates of overweight and obesity, they’re obviously going up in both the general population and the population with diabetes. Approximately 90% of patients with diabetes have obesity and are either overweight or obese, and 16% of them have extreme obesity, defined as a BMI of 40 or higher.

Overall, 50% had an A1c value of 7% or higher, 11.4% had an A1c that was 8%-9%, and 13% had an A1c value greater than 9%. Younger people have a higher A1c level than older people, which is particularly problematic because the risk for complications relates to the duration of the disease, and younger people obviously have much longer left to live.

So, 10% of adults aged 14-44 years had an A1c of 10% or higher, 9.4% of those 45-64 years of age, and only 2.6% of those aged 65 or older. In terms of hypertension, 70% had an elevated blood pressure and/or were on prescription medication for treatment of their hypertension, and 56.8% of adults aged 40-75 were on statin therapy.

If you look at the A1c goals for adults and you look at the standard goals — an A1c of less than 7%, a blood pressure of less than 140/90, a non-HDL cholesterol of less than 130, and being a nonsmoker — only 18% meet all four goals. If you use less stringent goals, meeting an A1c target of less than 8%, you find that only approximately 36% reach all four of these goals.

Clearly, we still have a large amount of work to do in terms of helping people reach all of their targets. I think that we need to be clearly aware of the problems of undertreated diabetes and obesity in underresourced communities. In particular, in light of the poor outcomes found with COVID-19, we need to work hard to create systems of care where we can improve outcomes.

There are probably higher rates of adult-onset type 1 diabetes than we know. I encourage people to consider adult-onset type 1 diabetes in people who clinically seem to be at risk.

Finally, we need to work hard both to prevent and treat obesity, because without this, we are never going to get our patients to their targets.

Thank you very much. This is Dr Anne Peters for Medscape.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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