Diabetes prevalence growing disproportionately across nation

The epidemic is most striking in states with high obesity and poverty rates. Focus is urged on preventing the disease rather than simply managing it.

By Christine S. Moyer — Posted Dec. 14, 2009

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Randy Easterling, MD, is a family physician in Mississippi, a state with the nation's highest rates of poverty, obesity and adults with diabetes, according to 2007 government data.

Many of his patients don't have the money to belong to a gym or buy healthy food, leading to obesity and eventually diabetes, he said. An even greater challenge is trying to break decades of eating habits centered on fried food.

"If you're talking to someone who is 50 years old and their parents and grandparents and great-grandparents ate that way, they will quickly [ask] you, 'Why would I want to make that change?' " said Dr. Easterling, president of the Mississippi State Medical Assn.

The answer may rest in the Nov. 20 Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention. The report indicated that diabetes is growing disproportionately across the nation, hitting hardest in states with the highest rates of obesity and poverty.

The report highlighted a belt of communities with high diabetes prevalence rates, stretching from the Mississippi River to the coastal Carolinas and the Appalachians, including many counties in Alabama, Georgia, Louisiana, Mississippi, Tennessee, South Carolina and West Virginia. In 2007, these states had a majority of the country's highest poverty rates, with Mississippi and Louisiana topping the list at 20.7% and 18.8% respectively, according to U.S. Census Bureau data.

"It should remind all of us that it matters what individuals do to manage [diabetes], but it's not the individual alone. ... There are some very compelling societal issues" that contribute to diabetes prevalence, said Ann Albright, PhD, director of the CDC's Division of Diabetes Translation.

Nearly 18 million have diabetes

Diabetes has been rising steadily in the United States since 1980, when 5.6 million people were diagnosed with the disease, according to the CDC. The most recent available data show that figure more than tripled by 2007, swelling to approximately 17.9 million Americans. An additional 5.7 million are estimated to have undiagnosed diabetes.

During the next 25 years, the number of Americans with diagnosed and undiagnosed diabetes could nearly double, from approximately 23.7 million today to 44.1 million in 2034, according to a report in December's Diabetes Care, a journal of the American Diabetes Assn. In that same period, annual spending related to diabetes would rise from $113 billion to $336 billion, the study said.

One key to slowing the epidemic is shifting from managing diabetes to preventing it, said Edward Gregg, PhD, chief of the Epidemiology and Statistics Branch of the CDC's Division of Diabetes Translation.

Albright urged physicians to "reach beyond the walls of your clinic" and become community leaders to combat diabetes. Doctors, for example, could help organize coalitions dedicated to addressing local health issues, she said.

"If we don't start doing something, [physicians'] jobs are going to be harder. We're just creating more and more and more people who will be developing diabetes," Albright said.

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Diabetes' steady rise

A CDC report says diabetes is increasing disproportionately, striking hardest in states with the highest rates of obesity and poverty. Americans diagnosed with diabetes from 1982 to 2007:

1982 5.7 million
1987 6.4 million
1992 7.5 million
1997 9.4 million
2002 13.6 million
2007 17.9 million

Source: Centers for Disease Control and Prevention, "Number (in Millions) of Civilian/Noninstitutionalized Persons with Diagnosed Diabetes, United States, 19802006" (link)

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External links

"Estimated County-Level Prevalence of Diabetes and Obesity -- United States, 2007," Morbidity and Mortality Weekly Report, Nov. 20 (link)

"Projecting the Future Diabetes Population Size and Related Costs for the U.S.," abstract, Diabetes Care, December (link)

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