1. A cross-sectional study of the NHANES (National Health and Nutrition Examination Surveys) data demonstrated an increase in diabetes prevalence between 1976-1980 and 2007-2010, particularly in men.
2. Body mass index (BMI) was noted to be the most important of the risk-factors contributing to the rise in diabetes prevalence.
Evidence Rating Level: 3 (Average)
Study Rundown: With the ever-growing cost of morbidity and mortality associated with diabetes, understanding the changing demographics of known risk-factors may contribute to public health efforts to curb diabetes rates. The present study compared representative samples of U.S. adults from NHANES and demonstrated an increase in diabetes prevalence between the periods of 1976-1980 and 2007-2010. This rise in diabetes was greater in men than in women and was accompanied by increases in the ethnic/racial makeup, age, and average body mass index (BMI) of the U.S. population. However, after adjusting for these factors, the increased prevalence of diabetes was halved in men (6.2% in 1976-1980 to 9.6% in 2007-2010) and no longer present in women. The change in BMI over time was the most important factor associated with increase in diabetes prevalence over the period of evaluation. This significant contribution of BMI to diabetes rates in both men and women supports and reinforces the focus of public health efforts to address the obesity epidemic in the U.S. Further research is required to explain the remaining increasing in diabetes prevalence among men. Limitations to this study include the lack of adjustment for other known risk factors including physical activity and mortality rates, which were not measured by NHANES. Strengths of the study include several iterations of sensitivity analyses, including different definitions of diabetes and obesity, which confirmed similar trends in findings.
In-Depth [cross-sectional study]: This study analyzed the data of 23,932 participants aged 20-74 from NHANES data between 1976-1980 and 2007-2010. A standardized questionnaire was used to collect demographic information and participants. Multivariable logistic regression models with diabetes as outcome and terms of survey year, age, race/ethnicity, and BMI were used to find adjusted prevalence of diabetes for survey periods. Mean fasting plasma glucose levels significantly increased over time in men and women without diabetes (5.0 mmol/L vs 5.2), but not in those with diabetes (9.7 mmol/L vs 8.9). Crude prevalence of diabetes significantly increased from 1976 to 1980 and from 2007 to 2010 for both men and women. After adjustment for age, race/ethnicity, and BMI, the prevalence of diabetes in men was significantly increased from 6.2% in 1976-1980 to 9.6% in 2007-2010. After the same adjustment, prevalence of diabetes in women was not significantly different between the two time periods (7.6% in 1976-1980 and 7.5% in 2007-2010). For men this increase was half of the calculated unadjusted prevalence. For women, the adjustment for BMI eliminated the increase in diabetes prevalence.
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