Lifetime diabetes risk rises as incidence increases and mortality decreases

1. An average American born between 2000 and 2011 was estimated to have a 40% probability of developing diabetes during their lifetime. 

2. The greatest lifetime risks were seen in Hispanic men and women and non-Hispanic black women, in which lifetime diabetes risks increased to over 50%.

Evidence Rating Level: 3 (Average) 

Study Rundown: Since 2000, the incidence of diabetes has increased in nearly all age, sex, race and ethnic populations throughout the United States. Concurrently, management and prevention practices for both diabetic and non-diabetic patients have been improving, thus, leading to decreased mortality overall. The authors of this study set out to estimate trends in diabetic incidence, mortality, and lifetime risk of diabetes over a 26 year period using data from 1985-2011 from the National Health Interview Survey (NIHS).

The results showed that the incidence of diabetes has been increasing over the past 26 years while mortality rates have been decreasing, resulting in a longer time spent with diabetes and a decrease in years lost to diabetes. The probability of developing diabetes during an average American’s lifetime was estimated to be 40%. The greatest lifetime risks were seen in Hispanic men and women and non-Hispanic black women, with lifetime risks above 50%. This study was strengthened by the fact that it was based on data obtained from a large national survey with a response rate of nearly 90%. However, limitations included that patients were considered diabetic solely based on self-report, there was no distinction made between patients with type 1 or type 2 diabetes, and the study did not examine morbidity in the living diabetic population. The authors concluded that with an increased incidence and decreased mortality, there will be continued health-care costs and a need to develop effective prevention strategies to reduce diabetes incidence.

Click to read the study, published today in The Lancet Diabetes & Endocrinology

Relevant Reading: Lifetime Risk for Diabetes Mellitus in the United States

In-Depth [cross-sectional study]: This study examined linked data from the NHIS and National Death Index for 598,216 adults sampled between 1985 and 2011. The authors compared diabetes incidence, mortality, and lifetime risk between three chronologically distinct groups (1985-89, 1990-99, and 2000-11) and estimated risk using a Markov chain model. The greatest increase in incidence occurred in middle-aged and older adults between 1990-99 and 2000-11. In 60-64 year old men, incidence increased from 0.73% (95% Confidence Interval [CI] 0.28-1.18) to 1.65% (1.31-1.99), and increased from 0.71% (0.32-1.10) to 1.51% (1.24-1.79) in 60-64 year old women. Mortality, however decreased during the same period from 4.4% (3.5-5.2) to 2.5% (2.3-2.6) in 60-64 year-old men and from 2.4% (1.8-3.0) to 1.8% (1.7-1.9) in 60-64 year-old women.

The overall lifetime risk of being diagnosed with diabetes from age 20 onwards, between 1985-89 and 2000-11, increased from 20.4% (95% CI 18.3-23.1) to 40.2% (39.3-41.3) in men, and increased from 26.7% (24.7-28.7) to 39.3% (38.4-40.2) in women. The largest lifetime risks were seen in Hispanic men and women and non-Hispanic black women, in which lifetime risk rose above 50%, with the largest increase seen in 20 year-old Hispanic men (26.0% [23.9-28.2] to 52.0% [51.3-52.7]). The overall number of life-years lost to diabetes increased by 46.0% in men and 44.0% in women, while the overall number of years spent with diabetes increased by 156.3% in men and 69.5% in women.

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