The Ongoing Rise in Diabetes, Mirroring Obesity Trends

Amid a steady stream of news from ObesityWeek, the CDC released new NHANES data this week documenting an ongoing rise in U.S. diabetes prevalence. Between 1999 and 2023, the age-adjusted prevalence of diabetes, diagnosed and undiagnosed, in adults rose from 9.7% to 14.3%. The total prevalence in adults between 2021 and 2023 was 15.8% – about one in six adults.

The prevalence is higher in men than in women (18% vs 13%), in persons with less educational attainment, and in persons with higher weight status.

Striking Trends in Diagnosis

Striking in this report is the fact that all of the growth in diabetes prevalence has come in diagnosed cases. These NHANES data tell us that more people over time are reporting they have learned from a health professional that they have diabetes. But in collecting NHANES data, researchers also measure blood sugar, either with 24-hour fasting glucose or A1c measurement. In this way, they find people who don’t know they have diabetes even though their blood sugar levels indicate they do.

The prevalence of people having diabetes without knowing it has not increased in the least since 1999. This is good news. People are paying attention and doing a better job of getting a diagnosis when they have diabetes.

Odds of Diagnosis Lower with Obesity

But an unfortunate and obvious fact is that people are less likely to have a medical diagnosis of obesity if they have obesity. Less than a quarter of people with diabetes and a BMI less than 25 have their diabetes undiagnosed. In contrast, for persons with diabetes and a BMI of 30 or more, about a third of cases are undiagnosed. This might be surprising because one might think that higher weight status would make health professionals more alert to the risk of diabetes.

But on the other hand, it is entirely consistent with the fact that persons living with obesity generally have poor experiences in healthcare and thus tend to avoid it. Weight bias and stigma are pervasive and pernicious. This is one of many ways that they undermine the health of people with obesity.

Better Obesity Care Should Help

This brings us back to the imperative for better obesity care. We have known for some time that good obesity care can prevent diabetes. We now know that new obesity medicines can prevent diabetes in more than 90% of people with obesity who are at risk.

The challenge that remains is to deliver obesity care at scale that can make a huge difference in new cases of diabetes. We must do it.

Click here for the new report from CDC, here and here for further perspective.

Evening Landscape with Rising Moon, painting by Vincent van Gogh / WikiArt

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November 8, 2024